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FOR OFFICE ELSE: APPLICATION FOR SANITATION PERMIT . Permit No. ......(Com late in Triplicate) . m This Permit Expires 1 Year From date Issued Date Issued .Z.:.... ..� Application is hereby made to the.San Joaquin Local Health District for a permit to construct and Install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATION .... ...AIF._ i. 1 �' -. /.'./.�n+.,r 2.._�.V.G................... ......CENSl1S TRACT .......... Owner's Name ' ........ :........_.. Phone ......,.. ............... Address p zloz �.. �- ............. City ....... ................. . Contractor's Name .._._ . � -----,License 9P ,f .. Phone l Installation will serve: ltesidenceAApartment Houseo Commercial[]Trailer Court Motel 0 Other .... . ............................ Number of living units------ ..... Number of bedrooms ... . _.__Gar a finder .. L Size ...1. .... .. ... Water Supply: Public System and name .. - ...__... ..........::.........Private Q Character of soil to a depth of 3 feet: Sand 0. Silt❑ Gay Q eat© Sandy Loom Q . Clay Loam Hardpan a Adobe Fill Material ............ if yes,type.....:......... ....... ..... lPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT ' I ] SEPTIC TANK 'ze. _r �� t ... ...: .......... Liquid Depth �1x�..`......... 0 Capacity Type .s -.- No. Comportments O r .... --- Material- .c............ 6 Distance to nearest: Well :4 .................Foundation :../.4 .......... Prop. Line f I ... LEACHING`LINE No. of lines ..___�...___...._...__ Length each line.-�. ........... Total length ........ .� i �TMiter Material _ "" --• YP .._.. _ . - •---Depth Filter Material ..... ..CJ............... ----...._... I Distance to nearest: We11 :R}_ �_....._ Fou dation pi Property C . Number ..._... Qck F�1led Ye ��rr /.�._.`.......--- -•- Pro er Line ... SEEPAGE PIT 1 Depth .C11-Y.-}-- Oiameter�/� s, No • I Water Table Depth : ._._' M ----------------------Rock Size . .SFS..:.... � -Distance tolF nearest:"Well L. ..................:Foundation.. i Pop I REPAIRADDITlGNIPrev. Sanitation Permt ........ Date �.. .} 37 1 Septic Tank (Specify Requirements) _..:.'. -:___-• _-- --- ,Gyv _ �_ 7. Disposal Field (Specify Requirement y -- ---._..p .f._._ � z t ______ ----- - ...................... -- F w existing ' w IDraand required addition on reverse side) I hereby certify that I have prepared this application and that the work will be don*'in accorclante with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Hort* owner or Ilcen- sod agents signature certifies the following: '' l "I certify that in the Afformance of the work for Itich.IN -permit Is issued, I shall not employ any person in such manner as to beta sub ec t War"m n"s Co '"" pensari n aws a California. .. Signed �__..._ .. ` Time :... _ By - ...--------- f -•------------------- - - - �. ..._ I f other than owner r l PART ENT USE ONLY l APPLICATION ACCEPTED BY ........ ---- i DATE :.... ..—��:��. . .............. BUILDING PERMIT ISSUED " " -'- ADDITION OMMENTS _ F ---- -------.DATE ........................................ ;' ::.. ...._.. --- ------------- ----- ................................. Final Inspection by: _._. .. ----- .........................:.. ..................Date ... /l' Ell J 3 2!I 1-6fi SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h M...... ....