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.. I (� FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........................�_{ .. - Permit No. .7T.r.�....3.. •" f� � t (Compiate in Triplicate) ' ............................... ....---•- - . `,.LL:• ,�. . Date Issued . :/. ..�.�/ This PermitE`xpires 1,Year From Date Issu d Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe T 's a licatia is made in compliants with County Ordinance No. 549 and existing Rules and Regulations: 373 �' - }� d. ..... 0 y Q TR CT ..........:..:: ...... JOB ADDRESS/LOCATION _ -j �7 IOwner's Name ..` � ...L�i 2��- •--•-•• ------------------�............-•-=......... .....__....Phone . .. .... ,�/ Y � Address ....�f-��.�1--�--l�� ."._��' .��...........................•-------......... Cit •f��...................................... ....... .. Contractor's Nome _.__ i..4-.•-� lh ................... License # ._ Phone , -. �.... Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Cam* f Motel ❑Other -•----------------------------------- ------ Number of living units:.._.___ Number of bedrooms __...Garbage Grinder -V_49. Lot Size �' ", Water Supply: Public System and name •-----------•-- -------.:..•--------- -------------------- ------------------------_--_---------.._Private %Character of soil to a depth of 3 feet: Sand 0 Silt FaClay ❑ Pet❑ Sandy Loam ❑ Gay Loam 0 1 �s f Hardpan ❑ Adobe jK Fill Material ............ If yes,type '`j l .(Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverso side.) I .NEW INSTALLATION: (No septic p tank or seepage pit permitted if public sewer is available within 200;feet,) PACKAGE TREATMENT ( ] SEPTIC TANKX Size./ ------------------------ Liquid Depth . .--••----------- Capacity'I1, f ..... Type� ' alt. Material.t /?�� ..... No., Compartments '.IF................. .._ Pro Line ../.. ----- IPI Dist6nceto nearest: Well ../ssQ.....................Foundation ..�J .::.... ._ p. LEA04II�tINE �j{( No. _of Lines - ------/............. Length of each line.l��--.---....__..: Total Length 1�.4�-�.........----•--- 'D' Boz T s Filter Material p f9 yp De th Filter Motenal�.. ...................:....... ... `' r rty .._..... Distan0.1 ce wtI f,o nearest: Well ,/ ...-_.___._ Foundation.; __ .._.. r"Props Line :.. SEEPAGE PIT �' Depth ��-�/_.... Diameter �� ... Number ..../......................Rock No Yes„ No Water Tafble i Depth ...............:..--•--......Rock Size..r.. Distance to nearest: Well ____, ....................... Prop. . Line ........... REPAIR/ADDITION(Prey. Sanitation Permit -- Date -••••` r ) -----..-.•........_ Septic Tank (Specify Requirements) •................•-•---•--•-•--------...,..............:`tom--.-----...:: .......... .......... - DisposalField (Specify Requirements) ........................... .............:r.:_ ................... ............................................ •-••-•---- t . Y i..........:... --------------" -1..... ------..__.........-•---------....:.. ------------------------------------------------- -------------------- ..................... •-- . ................. --------------------------------------------------------------- ----- ------------'-- .............. (Draw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will'be lona in'accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of"M San Joaquin local Health District. Name 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 BY ................ -........' ------. _.. Title . . w.:.............--------._.........--- (If of than owner I FO DEPARTMENT .USE ONLY APPLICATION ACCEPTED BY .._. _ -.. •---------•-•---••-••......................., DATE ..... . .. . .. . :... BUILDING PERMIT ISSUED ....• ..... .............:...............................DATE .................... ------ --------------- ....* COMMENTS ...... ' - �¢-fl- ------------- - : ........ -•-- ................................................. --------------------.............................. ..`........................ - ................ Final Inspection bY= .................................•-.................Date ....,. ._ ?r"..�I'� l SAN JOAQUIN LOCAL HEALTH DISTRICT r Le-13 24 ,_�AA D,.:- x — 7/723-111