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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Ni . .. .......^`... ••••••---------•.---•-.---•.••-"._.I......_I..---..... (Complete in Tripllcate) ........... Date Issued .7;:a:!�;7Y z, This Permit Expires 1 Year From Date issued ..._..Bina... is --••y'..........:.. q h Count Ord - 4 -w ermit to construct and Application is hereii'made to the San Joaquin Local Health Distract.ifnarnce No. 549 and existing Rulestalnd Regulations- described. egulat ons:cin described. This applacat�on is made an compliance with Y a CE TRACT JOB ADDRESS/LOCA I - ... Ae�... phone . Owner's Nome .m _ ___. �••---•----•- ....�---.....---•- Phone Address �f .7 .! ......_ Contractor's Name . - ••• . ..:................. ......... .......:.License # _... ....�---�•-• _.. . Installation will serve: Residence partment House Commercial ❑Trailer Court ] Motel ❑Other :..._... :....:......-........ + ) .__. Lot Size ._ ..,ALT �' r• Number of living units:__._.--1... Number of bedrooms .-----Garbage Grinded7 - -••-- ---•'•----•-- ••-.•------1---------••-----�--•--------•------•----------------••---- .......Private [� Water Supply: Public System and name .._...._.__ . Character of soil to a depth of 3 feet: Sand'❑ Silt❑� Clay E] _feat ElSandy loam ❑ Clay Loa ❑ _ a9 e ------..........----------- . Hardpan C] Adobe Fill Maternal . .__..- if yes,type (Plot plan, showing size of lot, location of. system in relation toS;wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit ermined '+f public sewer is available within 200 feet,] P PACKAGE TREATMENT [ ] SEPTI TANK Size_.. 1�,,�._....__.- Liquid Depth _ I mm - / � No.;Compartments!q...... ..... T _�I��:C� Yl .M +' `' ateria Capacity -4-'--•----.:.. yp e .. Pro Line .. Distance to nearest: Well > ......................foundation •••-----• P "" �'� ach line. Length '. ............ LEACHING LINE [l� a�a of Lines .._.. .... i I Tzj Length of e -� ._ T �e Filter Material�`� _pth Filfier Materia _... .. ............. -� _. YP D, 5a _� ----••-- ................. ti . Foundation:•..._ 0� Property Line _ .... Distance o nearest: Weil .:_. --•:-•--:.-• . ...-...... Diameter 6._ .. Numbers...:_. Rock Filled Yes [ o SEEPAGE PIT [ Depth Roc0; k Sire ..y�/;- -�`, Lane f Water Table. Depth •.X- —` Distance to nearest. Wei ._••.---- -•-( ' :.-f.- ...-Foundation v Prop• t ... Date .....................• ••---••--•_I ra REPAIR/ADDITION(Prev. Sanitation Permit _....--•-••-------• - ..--......... s ..................... ...-- - Septic Tank (Specify Requirement .•-.. .l Disposal Field (Specify Requirements) --•. ................ f --•--•-•-- Draw existing and re uired a I ( dditian 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 [icon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." ` Signed Owner I g x - ...._. title .._ ---- :.......---"�. �"� ..... ---- ... � (If oth n owner) FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED BY . !' ; DATE -----.......:.............................. BUILDING PERMIT ISSUED ........................................-••......................... aADDITIONAL COMMENTS ' ......--•------"- i.................................... .•-••---•---••-••---•-••......-•...............•. ------- --..."..._... ............ •s. y-•---. •. ---••• ................ ..: •-•--•........ - .... ---- . .. a �1.................. Date ." JOAQUIN LOCA( s _. .�yx�70-_ 1p ....._ Final Ins ection b �•7 •--'---"----"-"••'" •"" I P y: _....__ .. 1. - i' HEALTH DISTRICT SAN