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FOR OFFICE USE: 7tcocr�✓+ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ........_.......... •- •••.-----••-•-•-••-•••••--••••-•.............. ;This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Jo aquin Local Health Disstrid-forI aMlermit to construct and install the work herein described. This application is made in compliance witKt6uiityi6rdinance°No7549 and existing Rules and Regulations: JOB ADDRESS/LOCATION • ._ --A--(--G ,� :6'-.0 CENSUS TRACT ................... Owner's Name ................. _. .l..._ .. : ��Ir ..� o- :.< ...._ - . ..._......Phone _..--••--,...._....6 Address ............. �...:.. �� City _...:. Contractor's Name ... --•-•------------ - -License # ... Phone _.To_ installation will serve: Residence []Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other d. vS+wc •_ c -y -- - - Number of living units:.. ....___ Number of bedrooms ---------- Grinder ._:......,. Lo Size _....Z... ----. ......... I I m and na e ................................... •---_-• '......`,...--- PrivateCharaf Water Supply.- y• Public System f Water Su of soil to a cep"th of,.3.feet: Sand Silt Cloy t ❑ ❑ Y []�Peat❑ Sandy loam [] Clay Loam ❑ i ❑ Hardpan Adobe Fill aterial -,...... If yes, typel -------P � 9 1 (Plot plan, showing size' of lot, loca ion of system in relation.to wells,.buildings, etc' must be placed on reverse side.) t _ �W-.- NEW INSTALLATION: ,(No septic talk or seepage pit permitted if public sewer is ovarkrbfe4ithin 200 feet,] PACKAGE TREATMENT SEPTIC�,+4P1K--T-}---- size..----- • ----- .--A_ Liquid Depth .............. _..�. r !Capacity -- �.;_ Type_.._.....- Material_-, No.-Compartments ....................^ Distance, to-nearest?--Well ^- "-^ `Fbu�r tla'tior� .-- - 't Pro r Pr p. Line ................---- 1 LEACHING LINE ( ] No. of Lines Length of each line to aI dLen th` ............ } t �i gi ^ ------- Bcx -- - Type Filter Material '._....a_!. ..J,Defh Filter Material . oma* . ---•••...... :. Distonceµto"rearest:•Well`-'_______......_________ Foundation ...... -....._..._....� Property Line _._....__............. "'SEEPAGE PIT [ ] Depth ._-.-- Diameter ----------=----- Number ----- k---•-•,.......------ Rock Filled Yes ❑ No i(] Water Table Depth ----------------- --------- ------------ ....Rock.Size ............................. Distance to nearest: Well ------• ........... _---Foundation- •- ........... Prop. Line ................... t i REPAIR/ADDITION(Prev. Sanitation Permit# .............__ Date __._...._.:._-....-_.. i _...-_-.....) Septic Tank (Specify Requirements) ---------------.----------------------''Disposal Field (Specify Requirements) .._. . . ___- 'a _ -.-_- .................................... ...--•-- ..._.-- .... ---. .. � 9 ...... ---- . ............... rdw existing and required addition on reverse side) . i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California," Signed . - Owner —� Byc..... ::......_ Yitle . ....... . 1-31 A ........ ............ - ............... (If er than owner) FO DEPA TMENT USE ONLY APPLICATION ACCEPTED BY . - c.:........... - .yu/P DATE .. /..._..J.. ............... BUILDING PERMIT ISSUED .........:.. DATE ._..._-- •- .._._...... ADDITIONAL COMMENTS .... ............._.- _ _ _ ::: X.,, :.:: ::::: - .......: ::::-------- -------- ------------------------ ............. -- --:::: -- Z. - �'f Final Inspection by: ,,116t _4? � s � .. ate '.. .✓ D 247.3 SAN JOAQUIN LOCAL HEATH DISTRICT:, - ,. a E. H..13 24 1-'66 Rev,5M7/79 u