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FOR 61TICE USE: � APPLICATION FOR SANITATION PERMIT .......-- S (Comple41in Triplicate) Permit No. y': y... This Permit Expires 1 Year From Date Issued Dote Issued .......�....�..... R ,Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION .. ... Q.. _..--'•- -..........................CENSUS TRACT .:.:......._-_.,_.::.:.... I - �/ ' Owner's Name ...........I...............:.....................Phone Address ........................... ........................ City .................. ............ Contractor's Name ...G-t. .......License # I-. ./..�-. Phone r ,Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 I Motel C]Other ............. -•---••-.......... Number of living units:............ Number of bedrooms ,�-_4��4-Garbage Grinder .._.._ ---- .Lot Size ---� . ,Water Suppiy: Public System and name ......................... .....:...... Private Character of soil to a depth of 3 feet: Sand ] Silt❑ Clay,[-] - Peat❑ Sandy Loam ❑ Clay Loam i Hordpan ❑ Adobe4 Fill Material -_.. 1#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 permitted if public sewer is available within 200 feet,} r PACKAGE TREATMENT [ ) SEPTIC TANK size....................... .---------------------- Liquid Depth .....---•--------------_.- Capacity .................... Type .................... Material........... No. Compartments ..........: :.....: '" Distance to nearest: Well ..-•--,._... :..-.-•___-•.._.---:..Foundation ......_------------- Prop. Line ...................... LEACHING-LINE. [,-] No`:of Lines ....................... Length of each{line.---------:----- - ........ Total Length ...........................7 � 'D' Box Type Filter Material ................Depth Filter Material Distance to nearest: Well ......................-Foundation .........._:.........._., Property Line ._._.._....... ......... SEEPAGE PIT (.] Depth ..........:......... Diameter .............. Number ........,.._.............. Rock Filled Yes ❑ No.�] TTI 'I Water Table Depth .....Rock Size ______________________ -. €� Distance to nearest: Well .Foundation . Prop. Line # REPAIR/ADDITION(Prev. Sanitation Permit# .............................................. Date .................................. 7 Septic Tank (Specify Requirements) .....1.7.-'�71Q. s •�4r1-- �.e .. ............................w-•..-------------------------� i Disposal Field (Specify Requirements) .....j--- - ------•--------- ------ -----•---•- ------------------------------------------ G ----•••••-----------------•-------•---•-----------•-•-----•-----._........_.....------------ .............• . ..... .............------------------------------------------------------------ :- •-.......................... =................................-. ..................... (Draw ..._Y existing and required addition on reverse side) I hereby certify that i have prepared this applicationand 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 follpwing: _ € "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 Compensation laws of California." N j Signed ; ... 'Owner ..By �.. .... .. .tel - - ------- --- ................ ------------------• Title......I ------------•------•--- (If other than o er) i DEPARTMEN UKANLY + APPLICATION ACCEPTED BY . --Cu•••• •. G=- 0.,1�. ►-..� `DATE --- �..: ..:,7 f_----------- BUILDING PERMIT ISSUED ...................... .......L..... ----- . --•---.........DATE . .......................................... ADDITIONAL COMMENTS . ..... .... ...................... f ........... _.....••--•-------•--• ......... Final inspection by; ........ ................. ff.... .•. ......... ••-- -- Date .... SAN.J,OAQUI LOCAL�n� ALTH DISTRICT h� . . ..,.. .. _. r., _ �,. _ _ . : F_ w ..3 24 1.'AA Q..- SAIL 71723.2