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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................................. Permit No. (Complete In Triplicate) G=S� . ------ 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 the work herein described. This application iis,�made in compliance with County Ordinance N 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION J7C 'I GLS / ......... •......... ....... ..........CENSUS TRACT .......................... Owner's Name . ..---- �f� C �....... �. '............. Phone .. ,bFg..l.�._..._.. Address . . ........... .. '.l..dV -------- -- City ....................................... Contractor's Name _. ------------------ -------------------_-------- -- .........License # ........................ Phone .... ......................... Installation will serve: Residence Q Apartment House Commercial oTrailer Court 0 Motel NOther Number of living units:---l------- Number of bedrooms 9— Garbage Grinder ............. Lot Size ....1.. .............................----••- Water Supply: Public System and name ----•----•-•----------•-•.................•------------..--•-••----._......-------.....................---._...Private Character of soil too depth of 3 feet: Sand O Silt❑ Clay a Peat❑ Sandy loam ❑ Clay Loam ❑ # Hardpan p 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.)6 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size................................................ Liquid Depth ......................... Capacity' - Type - ? --- Material.gP. -.... No. Compartments ..=............... Wo Distance to nearest: Well ---- ....................Foundation ..�C---.._--_...... Prop. Line ___ �._ ......... LEACHING LINE K No. of Lines X................ Length of each line..... ........__. Total Length ...... _ Depth Filter Material .....�'1 fM t� 'D' Box Md —_. Type Filter Material .:...- ---- ---•-- . _ ......... Distance to nearest: Well .. ..#..._._._._ Foundation .._ Q........... .'F � � t ..... Property Line _..�............... SEEPAGE PIT Depth _015 ____-.--.. Diameter ........ Number .---.----1.........4....... Rock Filled Yes No iQ Water Table Depth .............................Rock Size Distance to nearest: Well ........................................Foundation ._........... ...... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .............------------•_.__-..---_ ----- Date ..............._ ................. s Septic Tank (Specify Requirements) ..--•--------------------------.........---••...................._..........- ......................... ...,.._..:.._.... -....... Disposal Field (Specify Requirementsl ------- --•----•-----------------------------------------------------------..---------------....--•- = - ------- - -------------------------------------------------------•------------......... ---------------------------- - (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 or Ikea- 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 as to become subject to Workman's Compensation laws of California." Signed .. ------------ ---- -- -r- _ Owner SY' !!-!f' ----- ........................................ xitle ----..._..... ..................than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ----- - ---- ----- -- •._.... - DATE .. 17 =SUILDfNG PERMIT ISSfIED ------ ---------- - - --------- •-- . _...._...DATEADDITIONAL COMMENTS ------------------- - ----------- •----------------------------- •-•---•------------------- _._............ Final Inspection by: .Yll�, _ ................................... •--..._Date . ."� ...._�..�.. 3 2!t 1-68 Rev. 5mSAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 3M '