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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT . f' (Complete in Triplicate) Permit No.l...........:_.... -- ---`__�......-..._ This Permit Expires 1 Year From Date Issued Date Issued e- '.J-S!:J� er E. �t �7c.�- <S ls7- 3v(- 0/ App kation is hereby ade 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 _4.0.0.4..R.q. CENSUS TRACT Owner's Name .................. .......111./.a-ar..19...............................-...........................Phone .'T7 �'a��f'••- Address .... ...................... ..1J....W...: A.. �. k�-9—�........------... City ...... R'T.."9. t4............... ._...............__. Contractor's Name ------------- V t.✓IP4..PJ 1S_Fl. .�a.7 5... .N.�.-.......License # ........................ ... .. .... ... Installation will serve: Residence❑Apartment House 0 Commercial OTrailer Court Q Motel ❑Other.---•....................................... / Number of living units: . ..__... Number of bedrooms ............Garbage Grin�or .......... Lot Size .._......4--T- r f / / ...- - -•-••-•---•---- Water Supply: Public System and name _..... .........._--- _ \ ? - :. J/.ce..__........... .....Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt Q Glay ❑ Peat❑ Sandy Loam Q Clay Loam Hardpan Q Adobe ❑ 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 sick NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 1 l Size........................................ Liquid Depth ....._.....„......».. . Capacity ------------------ Type --------------- Material................ No. Compartments ......._....„....... Distance to nearest: Well .............. .....................Foundation ...................... Prop. Lina _..„......„..„.._� LEACHING LINE [ ] No. of Lines Length of each line Total Length ............................ 'D' Box ............ Type Filter Material _....___..-.._.Depth Filter Material _............................... .......... Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ ] Depth ... ....... Diameter ................ Number .......................... Rock Filled Yes ❑ No C r^ V� Water Table Depth _.............................„..............-Rock Size ................................ I Distance to nearest: Well .....................Foundation .................... ProLim ...................„ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ...................„............. ) Septic Tank (Specify Requirements) 1.S.ISTCK.("r ...... .... ....... ..._...._....._ Disposal ield (Specify Requirements) Lll/4.. e..�.------. „-..„---_---�............... ._...�.L-6�-..._...T._ `.�_(.:f.!. s.._ `�iOJ-��'.K.�r.},.. ._...G........._...... . (Draw existing and, equired 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 b1mme ub' ct to Workman's Co "nsation laws of of California.” Signed�.l.L�. .t /-1. �.1...� {..<F: ©. . .. .37 7 g=.-.......6wrtec BY -..... .._.... - ..... . . �.N. n__RTM Jitle (tf(lf other thian owner) FOR ET USE ONLY APPLICATION ACCEPTED BY ... ...................................................................................... DATE - �f. _...F.......: BUILDING PERMIT ISSUED ---------------_I_---------------------------------------.DATE __ _.......................-------- ADDITIONALCOMMENTS ...._-.... _.................-- ....... --........._....-_....._._... . .- . . . .. ._.... - ..._............. .......... ...... ... ........ .-......_._..........----------_ -- . .......................................... ......... _. - - - - .............. .................-.. ... ------- --------- ^ . .... .. ... ....... .... .. . _ .....------•--- F;nal Inspection by: . .. ...Date ._�..�.�.... ......... ' EH 13 24 1-6i3 Rev. /�. . . . ..... ..... ... SAN JOAQUIN LOCAL HEALTH DISTRICT $Z7h 3M