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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .........................I........ Permit No. .. . ' (Complete in Triplicatel This Permit Expires 1 Year from Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..__....._� 8_0_.__�-.••Nl-! -.. .../ /..Ift~i✓T ....�-CENSUS TRACT ......................... Owner's Name ... G_--•.-li1/i /�/�.►-t S ......Phone �Z3-36/U Address ......... a.7.7� / .L! M6,0/iCity --AIA•--------• ....................... ............... Contractor's Name __U !✓ ._.. /L An., S License � phone ....---• -•-•---- •--•-•••............. •----•------ ................. Installation will serve: Residence©Apartment House] Commercial{]Trailer Court 0 Motel ❑Other--------••.................................. Number of living units_____________ Number of bedrooms ............Garbage Grinder ............ tot Size Water Supply: Public System and name -.-.-•___._. Q. -----••-•-•--•-....----._�........................................ .......Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe 0 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 pit perml if public sewer av it blew in 240 feet,) PACKAGE TREATMENT j ] SEPTIC TANK f I �G/$�/ ;'S ---------;FV...N.. �'`P d Depth .......................... Capacity -------- -----•---•- Type --------------•----- Material---•-• --------------- No. Compartments .....................- Distance to ne . Well ---_-_.. - •---------------- Foundation ...................... Prop. Line ...................... LEACHING LINE �Af -�/4Jg� [ j No. of Lines _. _ _-. � ll'en t�of each line............................ Total Length ............................ ,E,JC/ Type Filter Material ...Depth Filter Material .S /� b' Box ._...__..... yp G Distance to nearest: Well ........................ Foundation ------------------------ Property Line ........................ SEEPAGE PIT { j Depth -------------------- Diameter ._......_..._— Number ---------------------------- Rock Filled Yes ❑ No 0 - Water Table Depth -----------------------• .......................Rock Size •--•--•--••-•-•. ............... Distance to nearest: Well .......................•_...............Foundation .................... Prop. tine ............_..--_._ REIR/ADDITION v. Sanitation Permit# .:�n....................................... Date ...-•----------------.......... --•! �. S�eSep#ic an (Specify Requirements) ...----------- -------------- ----•---------------------------`-------------------._....------ - ._. r.. Disposal Field (Specify Requirements) -----------.�-------_(�-�.. L� �'" -`�iV� .•-• .. ----- --------------- ----------- ..... ............. -•••--• - X � �.----.---.-•-�-.... -------- ..------.-- ...................... (Draw 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. Horne owner of licen- sed agents signature certifies the following: "I certify n the performance of the work for which this permit Is Issued, 1 shalt not employ any person in such manner as to bec a bject to rk n' mpensation laws of California." Signed _.. . --••----- Owner `^ ._. BY ------------------------••-- ----• Title ---------------- -- (if other than owner) F EPARTMEN SE ONLY ' APPLICATION ACCEPTED BY -- ------ ----- -- ---- --- ----•------.-•-•- DATE -3 J 7�. ----- L BUILDING PERMIT ISSUED --._.. DATE --------------------- --- ------------------ ...._ ............................. . ADDITIONAL COMMENTS ------------------------------------------ ------------ _ --------------------------------------------------- - ----- -- --• -------------------•--------------------_. .. j Final Inspection by: ..- � � -------------------- .......................... .._. ...-....Date ....--- ...r-- EH 13 2!� 1-•6f3 Rev. 5m SAN JOAQUI LOCAL HEALTH DISTRICT 874 3M