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a Al. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �— 7� ......................................._.__...... _ Permit No. . ..__... _.. ___ (Complete in Triplicate) ., JI Date issued ...�........... . f._._--•._ This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complianceywith CountyrOrdinahc'e'No�5d9 and existing Rules and Regulations: e � r JOB ADDRESS/LOCATION -,q.Y.9J9f7... �.. /��JrtP'G -------------- . .-••-..CENSUS TRACT ............_.............. Owner's Name ..l��dt ....moi!_.<- GiC� ............... - ...__.... Phone ..._........._........... h �.' .-.... ............ City /�i./ 04p17...._.. ; Address _. 504/ C 1 t � .a Contractor's Name --..le = License Phone.. ..... installation will serve: Residence ❑ Apggrnenf House❑.•Commercial ❑Trailer Court ❑ Motel W10ther --- ---- ------- -------- 1 Number of living units:.. . f Number of bedrooms },6----�-Garbage Grinder IVP.... Lot Size l'�.��1. ... ............ ' / Private Water Supply: Public System and name !'l i.!/._I�t�I� l -------......---_.• -------��-------• ................. ❑ Character of soil to a depth of!-feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam X3 Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ...... If yes,type _.......- (Plot plan, showing size of lotlocation 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,} PACKAGE TREATMENT SEPTICTANKj ] Size..................... Liquid Depth .................... � Capacity .. _ ...... Type .................... Material.......--- ...__.-__,No. Compartments .--.----_--_---_-� Distance to Aeorest: Well . .......... ---------.•--........Foundation ...................... Prop. Line '--....---------_-•. LEACHING LINE [ ] No. of Lines . .. ......... ..... Length of each line ...._..... ......... -..-.. Total •Length ....... .................. 0 'D' Box .__... .L.. . Type Filter Material ----------..Depth Filter Material ____ _ -__ _:-_T� _ Foundation ; --�---- ---•- Property •_..---•............. Distance to nearest: Well ....................... ty ` ...... Pro ---'r.................. � ,. SEEPAGE PIT [ j a Depth _. , . ._ Diameter .....__........ Number .......... .............. .. stock Filled Yes C3 No (]. `" Water Table Depth -- ................................Rock Size ...................------------- I --- -----•I Prop,•-Li . Distance to nearest: Well -•......................................Foundation --•-.---.. ne REPAIR/ADDITION{Prey. Sanitation Permit# ----•........---•-•...............•-•------. Date ---------- Septic Tank (Specify Requirements) ........ .............. ------•--•- - 1................... Disposal Field (Specify Requirements) _ - a,�� <-• P�/= h�� = ' "r f ........... x ?�1.3.�. .. .. ..._......_... .. ... ... _ ---. - - --.---... 9 (Draw existing and required addition on reverse side) I hereby certilt 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 licee- sed agents_sidnature Certifies the following:-- "I ollowing:-- �— - " ,in the performance of the work for which this permit is issued, I sheill not employ any person in such annex certify that California. as to become subject to Workman's C ,om laws of p6nsation i ;Jr "' i •�` Signed ...i ...... ------ ---- ---- ----- ----- ------ +Owner CI 1! (If ather. an owner) .�..�. ._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ( --------- DATE ........ ............ ....�,f - BUILDING PERMIT 'ISSUED. ....... ....... . .... ..... ----......-DATE ......................... ---•-. ..__._.._- ADDITIONAL COMMENTS ....-.........._-�_--�--_-----w-----,--m--_--- ----........, —. _....-_.. ---------- ------------•------- •--..----- "" :....----•,-........................ .... ......- •----•- ...................... • '"`*�'.� '-..i1..^4.�.,.,..`.� r" .<1 - tit y,., •'t - x�-.,...r _ ...--- ............ -- .------•-•--- ------•--..._... I . ------ = -'- ---- ---G� ............. ---..... . ... . - ............. .. . .._ ... "_ --------- _ Date .. ; Final Inspection by: - .......... ------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT