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FOR OFFICE USE. k APPLICATION FOR SANITATION PERMIT 4Complete in Triplicate) Permit No. _.��-. -••- ..................:. This Permit I~xptres 1 Year Fram Date Issued Date Issued .S... ..T L Application is,hereby-made to the San Joaquin Local Health District for a permit. to .construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION 7j f/ ....... j�C� .-.........CENSUS TRACT ../.. ............... Owner's Namef.1C1f�1/�/---[.44-4*._ rry -7............................. Address .3� 7 G7��sj-" ........:........//'l.. G1 ...........'.. City -G .....................Phone ......... Contractor's Name ... �icrC�G ., ' ✓rl�.C--G--------------...........License # _ 0-,(J9. Phone Q��--- S Installation will serve: Residence Apartment House❑ Commercial`❑Trailer Court 0 5-Motel C]Other _ t Number of livingunits:- -- l _.. Number of bedrooms ._- --Garbage Grinder AV.. Lot Size ... .. ............................ Water Supply: Public System and name - -------- --- -- - v k 1'ri pte Character of soil to a depth of 3 feet Sand X Silt❑ Clay,:b Peot❑ Sandy Loam ❑ Clay Loam D "j - r Hardpan [ Adobe ] Fill Material If yes,type ' ;. (Plot plan,.showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side NEW INSTALLATION: (No septic tank or seepage p`it permitted If public s wer is available within 200 feet,) TREATMENT [ } SEPTIC TANK; ) � lSfiruO SizeLl�/l� . -- PACKAGE TRT IC ., .-----/ �.. Liquid Depth _-.....----•----------:-•----• Capacity��l=J� ... Type &�<- - - - - --- Material-- -•-----" � i _ -___-- No. Compartments -._-•-•...•-•---_ Distance to nearest: Well ,.!00--f...:...............Foundation .......... Prop. Line ................ LEACHING LINE [ ] No. of tines ........................ Length of each line..............................Total Length .. , 'D' Box ............. Type Filter Material --------------------Depth Filter Material ............................................ Distance to nearest: Well .�;-- ---•---••-•-!._-- Foundation .................... Property Line ........................ SEEPAGE PIT [ ) Depth ------- ------------ diameter ................ Number .--------.....-----.........-- Rock Filled Yes ❑ No �] Water Table Depth ................................................Rock Size ---------••••-1••-----------•--•- Distance to nearest: Well ------------------------ -- ----------Foundation ........... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# ...................................... .... Date ................................ Septic Tank (Specify Requirements) .........................................-----.........---------••--•--.... • ........ Disposal Field (Specify Requirements) ... �1---•-•----- ............ .......... -------------------------------------.....------------ ------------•a-------------- _---------- ----- (Draw existingand required addition bn reverse side) I hereby certify that 1 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 fallowing: "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 bec subiecf to ►llFgrkman's Compensation laws of California. . . .... ---- -- ------------- ------ Owner- By •---- •-----------••--=-------- - -----•--------- --------•--- Title -...' (If other than owner) F DEP RTMENT USE ONLY APPLICATION ACCEPTED BX --- - DATE ..---... . ?Q _7C-•----------- ----------- --- - ----------------- = BUILDING PERMIT lSSlll~D ------ -- ------ - DATE ...---- -------------------------------- 7 ADDITIONAL COMMENTS .QI� rah rte- t --�zR .Wl�F,- G4�l rpm - .----•---- ---------------- ------------ •------..---------------------------•-.- .................. ---- ...............•-------••----- ..... ----- - ---- ----- --- -•------------•----• ----------- -------•-- ........................ ' Final Inspection by: ..-. .:. .-. ----------------Date �1 -[--- ` EH 13 22 1-6 SAN JOAQUIN LOCAL HEALTH DISTRICT y 8/7h 3*