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. t FOR OFFICE USE: . . I . _ . _ . . . � APPLICATION FOR SANITATION PERMIT /aa Y ................................ .............•- permit No, .7t (Complete in Triplicate) ....... This Permit Expires 1 Year From bate Issued Date Issued ............. 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: i l F JOB ADDRESS/LOCATION . 0I �`��- -.fr.� ��. ..,/ 1/' ................................CENSUS TRACT ...............-- -- 1 �..,........•-............................ hone .��r^'16�.. ..... Address .. ............... ......................................... Ci#y ..,,[1. �1�'f/". .._..: .:.:. }._._......:.-•--•... k Contractor's Name ... 5.... &V .......License # �� - ._Phone y� r'�=-,?� G 4 Installation will serve: Resiclence:_W Apartment House❑ Commercial ❑Trailer Court ] . Motel-p Other-_ -_- _.. ......................... �. Number of living units-J____-.- N mb�er_of bedrooms '"___,(...._Garbage Grinder (/�7-_ tot Size _A�_ •�' •............. Water Supply: Public System and n&me .............. .....Private 4 Character of soil to a-depth of 3 feet- Sand LRI _Silt,[] •.Clay,❑ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑; ;r Adobe 0, Fill Material ............ If yes,type __----_---_--------- .7 . _----._.---_-.------_ (Plot plan, showing size of-lot, location of. system`in rel tibn. to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,permi#gcl if public sewer is available within 200 feet,) I, PACKAGE TREATMENT [ SEPTIC TANK] _ 5ixe.___ .. .. ,.o�....._.."_--•. Liquid Depth ...'�................. Capacityla.--_-•-• TYpe � Materia .11�� Na. Compartments c .......:... ..... a i - - Distance to nearest: Well ,/C�e?__".....•-----•-____--..Foundation ../0....'.--..--.. Prop. Line _.��.............. } r 41EACHING LINE [4 No. of Lines _._... ....... Length of each line.___7.0-__- `-- Total Length ..,l.�f ......_.:... I'll D' Box - Type Filter Materia) /l'dC ..Depth Filter Material _1.. ... ........................... .... Distance to nearest: Well ._�Q�.�_-.....: Foundation _-./�..�_._..__.... Property Line _nrc................. SEEPAGE PIT [ j' Depth ."". -------------- Diameter .............-_. Number .........................__. Rock Filled Yes ❑ No ❑ Y� Water Table Depth ................ Rock Size Distance #O nearest: Well ------------------•--•-.................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation' Permit# --------------------------------------- .................. Date ............................... ) Septic Tank.(Specify Requirements) ...................................................................................................................._-__------------....... DisposalField (Specify Requirements) .....--•........................................................._-•-----"---_..._----_---- _---._._....-------------•-_ ..--------•-------- ---------•- ...........................................--•..................................... ----••-• •------------ --....... ......... (Draw existing and required addition on reverse side) 1'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, 1 shall not employ any person in such manner l as to become subject to Workman'i Compensation I ws of California." S Signed ...............................•--•----.....°.---------- -------- ........ ............._.. Owner ..._ ... ................ .... . .... •-• ----. --------By ........ Title Q (If other than owner FOR DEPARTMENT USE ONLY APPLECATION ACCEPTED 13Y .. .._. ...._.-__-•--- ------------------- DATE ._..ld' '��L.......-•---- BUILDING PERMIT ISSUED .._ ....................... DATE _..._.............. ' ADDITIONAL COMMENTS :....... .... ' ................... ......................... .......---........_.._.....--•-- --•.._..... {-----•-• -•----------- ............... ..,. Final Inspection by: I'M-1111 ....... .....................•---.......-----......-----.4.._....._...---.....--------.Date -------•..................................... x SAN JOAQUIN -LOCAL HEALTH DISTRICT c u 13 241_-Aa o... Rm 7./723-m