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.. _ fS)____1'FOR OFFICE USE-APPLICATION ?R SANITATION PERMIT -1 to l�1�! I Per No. ...�:��`�...._ . .............•-•-........_... 1 T � {Complete in Triplicate) ........_........J�............... Date Issued ... .-.. ....�3 This Permit Expires i Year From Date issued 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: r - 3 .rE-.-_✓L[i.0 rte_ TR JOB ADDRESS/LOCATIOON ,/Y..IrV.-. C ... ................. /' NSLIS ACT �P- 550-05 Owner's Name ...J ?, Cd __ . �- ._............. hone ........................... ....__. qq ! ......................................... City :/ ? �.%,i .p......------•--....... ..�. ...... Address --.�G��-�...�' ��'.r'��f :.. � �,� .. Contractor's Namr, ...- -- License # '� ��' --. Phone u Installation will serve: Residence%Apartment House❑ Commerciol []7raller Court C] Motel ❑Other .....................__------------ ..... � ..< Number of living units:..-.:4.... Number of bedrooms _Z.,......Garbage Grinde >--- Lot Size -- -__ .;K,_. A ............... Water Supply: Public System and name .... .................... Private, Character of soil to a depth of 3 feet:_ Sand❑ Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ---------------------------- `�, d -'f ' Mot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (nt NEW INSTALLATION: (No septic tank or-seepage pit permitted if publicJsew6rs available within 200 feet,) ` . PACKAGE TREATMENT [ ] SEPTIC TANK ' ize.! L?�.. �i................ Liquid Depth ---•-•.•.....------ Capacity � Typef� r_ _ Material._�.��e?.. �.s. No. Compartments ._, � ..`........ �. .. Distance to nearest: Well -_--- ifs'.......................Foundation _.......--_-- Prop. Line .. �i'......-__-•- or LEACHING LINE No. of Lines ._. - . ��................ Length of Each line.-'::::�,,'"--7f------......---- Total Length 1',�-•sti'�•-............... D' Box : _ �__ Type Filter Material` ! Depth Filter`MBteria,l ._.•................. ...••.•.•. u -. - �e ... Property Line a Distant to nearest:'Well �.�--..-------• Foundat.ian- ... �.._.._...... SEEPAGE PIT Depth .�._:_:. Diameter ,�. ...r.__ Number ___... -... .......... Rock Filled Yes ] No ,AP .Rack Size .........r Water Table TDepth/__:.- _�......................... .. Distance to nearest Well ._..,�--.1 ...................Foundation ,� ....... Prop. Line -..........-_ REPAIR/ADDITION(Prev.FSonitotion'+ermit# ----_------------------ .................. Date .............. ------------------- Septic Tank (Specify Requirements) _ ..-- ---- ....................--........................................-................•...................... Disposal Field (Specify Requirements) ------------------------ ----------••-•------------ ----.......__...--------.......------------•--•--•----•-------•--..... ----------------------------------• --------............................................................................................ (Draw existing and required addition 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. home owner or licen- sed agents signature certifies the following: "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 1 t ................ (If er than owner) FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY ..... ............... DATE .:. .. - ... BUILDING PERMIT ISSUED ....-•-------------- ....... ------------ ...........................................:._.._.........DATE ----- . -- ....... ADDITIONAL COMMENTS .......................................... ------ - ----........- . .........................<.............. _.. r � .4. -- . - 4 .................................................._...___ ..__.___._._..._....... ...__._......_.....__..........-__......._........_'_....._ ....-_-----' •--- ..... ... .... ... ?.._.. Final inspection by: :. ----•........................................Dae ... --SAN,JP UIN„LOCAL HEALTH DISTRICT 7/7231