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rU*OFFICE USE- ...---- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..............--•---- Thls Permit Expires ' s� _.... .................. res 3 Year Data !sawed • • Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work h described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations.een JOB ADDRESS/LOCATI N .. .� � ... 1-5-, � /rJ ��--��,/ GlIlkENSl1S TRACT Owner's Name / (.C..I..-•- �,.rl---�1��. •......... ............... Address ............................ .... Phone / ..... city Contractor's Name -----CI '=--� _ .•- ---- -----------------------------------------------------License # ........ Installation will serve: ResidenceXApartment House Commercial❑'frailer Court ]_. Phone .......................... Motel ❑Other.--- . . Number . . . . . ............... of living units:_.._�_...._ Number of bedrooms ..2-._.Garbs a Grinder A -..... Lot Si Water Supply: Public System and name "' _�Y.O .2 .,1 __,� ..._....................._.._... .........Private.0 Character of soil to a depth .................................... F p of 3 feet: Sand❑ Silt ] Clay 0 Peat❑ Sandy loam ClayLoam Hardpan P Adobe❑ Fill Material ........... If yes,type (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be ptpced on reverse side.} ^' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) n PACKAGE TREATMENT [ I SEPTIC TANK ►� Size..................................•-••-•--•----- Liquid Depth yy Capacity .......................... •------••- --•-- Material----- -•••-----••---.. No. Com - Type --------------- Compartments Distance t ...................... o nearest: Well .._--.-_ ..Foundation } LEACHlN ------------------•----... .._ Prop. Line G LINE _...-----•-------.. 1 No. of Lines ..................... -------------•-----••--- Length of each line.____.....---•-•-- -- Total length . ' Box ............ Type Filter Material%-------------•••._.Depth .Filter Material Distance to nearest: Well ,... -.•_____________Foundation -_.:......... Property Line SEEPAGE PIT .l 1 Depth ........................ •-----•• --- Diameter ................ Number .__........................ Rock Filled Yea ❑ No ❑ Water Table Depth _.._ ------- ...................................Rock Size Distance to nearest: Well ............................... ...Foundation .................... Prop. Line ...................... REPAiIt/ADDITION(Prev. Sanitation Permit# .._:..:_.- -------------------------------------- Date __.. Septic Tank (Specify Requirements ...............} • ----- Disposal Field (Specify Requirements) l ----------------- Disposal a '...._ .. -- f 01 . c.rra_. �e.._ Z.... � .....__. .......... _ - ._.... ._ _ f�/.Jr................. (Draw existing and required addition on reverse side) - I hereby certify that 1 have prepared this application and that the work will be done in accordance vdfh San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Homi 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�Componsation laws of California." Signed ---•-- • r s4,f'.---••li__11 .r , -r caner BY ------ (if other than owner) ----- ------ ----••------•------• ----- -Title '•• { APPLICATION ACCEPTED BY .--.- D TME T USE ONLY- BUILDING --- PERMIT ISSUED ---- -- ----------------------_ DATE ADDITIONAL COMMENTS _ ._.. DATE . -•... ............ ... .. . ... .. .. -----...... --- Final Inspection by: ------ ------------------ 13 24 2-6Re ---- - ..:- -- - ---Date SAN JOAQUIN LOCAL HEALTH DISTRICT $I 3M