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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit Date This Permit Expires I Year From 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: JOB ADDRESS/LOCATION-------/-5-7111- /P N. - Phone__C� Owner's Name.- ___ �,f". .fint- „ US ' ----------- --------�--- ---------------------- �' Address ► ;,- . - Ae2-- _- s ---e- - _ L -- , � , _ _,.__... i_...._ - " City _ G _Zip------- --- Contractor's Name-------------- �- s 5�Z7 " d-+ 5-- 7"----License #._ 8 -__,_ one_`.T :Ph6 - G _ , Installation will serve: Residence I-] ApMtmentt'W-0usep ommercial 0` Trailer Court„( : Motel E] Other____-/1- 00P le Number of living units:-----/ _.__.Number of bedrooms_______.Garbage Grinder------------Lot Size- Water Supply: Public System and name------------- _ -__-_- __-11Z tj__private [ ► - - - - Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay'E]-- Peat❑ Sandy Loam N' Clay Loam Hardpan ❑ Adobe ❑ Fill yes, type_____.____±_________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sidA) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200ffeet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size----__F____________________ , ` - Q i ---j Liquid Depth.------- Capacity-�.��_Type_/f e C�$ f ' _ _ _ Material___[�fer rre!J No. Compartments___.---- Distance to nearest: ---- _ -----Foundation_AV� t ] ZS �= - • Prop. Line----------------�- LEACH INOUNE`1jr'No:of Lines_-.-. �----_ Len th of each lins.__-___ __ �- �.- g 7 -------Total Len th - -----1 a l 'D' Box- �5___Type FilterNlaterial -Depth Filter Material______.___--l__.___ �_-_ Distances to nearest: Well____G-------'�'L__.Foundation----- __ ------property Line--------- SEEPAGE P!7 [ ] Depth----------------Diameter--------.-----------Number----- ----------- Rock Filled Yes ❑ No ❑ Water Table Depth-------------------- -----------Rock Size Distance to nearest: Well--- ------------------------ - ----------.Foundation------------- ---' Prop. LiI elne s REPAIR/ADDITION (Prev. Sanitation Permit#--------------------------- Date ------------------------------ - Septic Tank (Specify Requirements)-----------------_--- -------------------------------------------------------------- '° L -11 4---------------------- Disposal Field (Specify Requirements)---------.-_------_ a ___ __________________ tf __ --------------------------------------------------------- v . _______________ -------------------------------------- ------------------'_ ___________________________._---_____ i r 1, ----- -------------------- ------------------------------------------------------------------------ -------------} ------------------- ----------- (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application and fhat the 4ork will be done in accordance with San' Joaquin County Ordinances, State Laws, and Rales and Regulations ofjthegSan Joaquin Local Health District, Home owner or licensed agents signature certifies the following: ; j I "I certify that in the performance of the wo k"for,which this permit is issued, I shall not employ p y an y person in such manner as to become subject to Workman's Compensation law hof California." ] Signed----- r---'. --�-�, ._ — I i �c1---- B --- ---- ----------Owner" By-------------------------- ---------- ---------------------------------------------- 1 --------- Title- ------------------------------- --------------- (If other than owner) I FOR(DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ __ ___ ______ DATE ___._ -- -------------------------- DIVISIO NOF LAND NUMBER _______________ 4 IONAL COMMENTS_________________ -- DATE--- --- -- ----- ------> ------� _.,_—._ - -------- ------------- --------------------- _ , _ ---------------------- --- ------ ---------------- --- \f " 1 f t' ------------------------------------------------ --------------- -------- inspection by:,- ------Odle. = 7 ----------------- SAN JOA UIN LOCAL HEALTH DISTRICT Fs`.�7J!ii�i 7/76 3M �N