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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......................................��,3.:?�.... - Permit No. ................... .5"9 g 3 o (Complete in Triplicate) .......................I.............. .......... This Permit Expires 1 Year From Date Issued Date Issued _711/ ..7„7 Application;is hereby made to the Son Joac{uin,Loca) Heal'th.Di6ricttfor 4a` permit to construct and install the work herein describik-This-application is made'in compliance with County Ordinance rNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION AV-. ..d��.j.�� l�i� :'�:......-•........................CENSUS TRACT ......................... . Owner's Name Beep<-__ � ��............ --------•- Phone ............. Address .........._....City `F � ....... ...................... ... Contractor's Name d -•~~-- --off,/Y.l------=........................ ........License # 9;71-O. .. Phone O.,; tl. Installation will serve: Residence ❑Apartment House C] Commercial ❑Trailer,Court 0 Motel ❑Other ------------ ---------- ..................... Number of living units._/.... Number of bedrooms -.-Garbage Grinder/.�Q.... lot Size J .......... Water Supply: Public System and name ----a. to ..... -s, ',-,f w----•--------=-------- .Private ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat-E] Sandy Loam 0 Clay Loam 0 Hardpdr3 ❑ Adobe; f 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,)- k PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size............................._---.__....._---- Liquid Depth ............, ._.....-.-W Capacity ...-• --....--•----- TTP® .................... Material---------------------- No. Compartments .........._.Mi Distance to nearest: Well ............................... ....Foundation ...................... Prop. Line ...._.......... ...... LEACHING LINE t ] No. of Lines _--------------------- Length of each line-------I.................... Total length D' Box ............ Type Filter Material ....................Depth Filter Material ---•--••-.•..............._.............:... ; Distance to nearest: Well ........_.. ....... Foundation ........................ Property Line .------•._.._.__--_-•--- 3 SEEPAGE: PIT [ J Depth :............. Diameter __..._........._ Number __..__.._.._..._....._.._... Rock Filled Yes ❑ No ❑ k� Water Table De Depth ..Rock Size 0 P f Distance to nearest: Well .......---------------------------------Foundation .... ............... Prop. Line ...................... I REPAIR/ADDITION(Prev. Sanitation'Permit ........................ ................ Date_......I...........................) 11 ofte Septic Tank (Specify Requirements) ...............:...... ...................... .......... ----------------. -. Disposal Field (Specify Requirements) ---. --.. T.-_. -: ... - V/.r.7 ............. ............................... ..................... ---............................................_.._.......................................................... .................................'........--.-__--._ (Draw existing and required addition on reverse side) 1 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. Home owner or licen. sed agents signature certifies the following: ti "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." Signed --------- -- -- -- -----------••-• -•--- -- ..------........ .............................. Owner - ff BY -- . Titled „',................................. f other than owner) FOR IMPARTMENT USE.ONLY ; APPLICATION ACCEPTED BY ..A.4:0..4Q. .. .............................. -•..-:: :`..............---- - " - ._'. DATE .. ,� .... ............... BUILDING PERMIT ISSUEDDATE ..... ........ ......................................... . ADDITIONAL COMMENTS _._. ... .. ..... .... ---- .L` .. ,..-• /�M...._`✓....... ....................... .. ............ ................................. ......................................-......... ..... ......------------- ...... ........... ' . . . ....... ----- . 3 �..... ate_..--- .... Finalinspection by: ..... .......................... ....... ................ ----- is,.... D 1_ _-SAN JOAQUIN LOCAL HEAL';?H DRICT_. w r i, 1.3 24 , .zn n--- —