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FOR OFFICE USE: �` �.�� -- g- APPLICATION FOR SANITATION PERMIT Permit No. ._ 5:. G� fComplete In Triplicate) ...............•----....._.I.....-----......_._-_--•-.... This Permit Expires I Year From Date Issued Date Issued .l°. 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 ode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ......7 .. __7- - - -.•�,7 ..---.. . . .. ... .... ..............CENSUS TRACT ....,..................... Owner's Name A-A Phone 4��•3� r /�..__. Address ............. .... ................ .......................... ------- ---•.. city.3"rr-trv-yf...................................................... Contractor's Name ......X)_cA-P*Aa,!s-&._v�q-&ee/7-v......;C„1�......License Phone A Installation will serve: Residence 0 Apartment House 0 Commercial C❑Traller Court ` Motel ❑Other .................•-..................... ..__ ; Number of living units:_.,_...... Number of bedrooms 3.....Garbage Grinder ............ Lot Size �e...5 . . _.._ . _. ........... Water Supply: Public System and name -------......................................................................................................Private I Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam P1 Hardpan❑ 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 side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT f I SEPTIC TANKize...-• --�. -cf-/................... Liquid Depth I/........ .1 Capacity .1.21-00 .... TypeMaterial No.No. Compartments ............ .S Distance to near st: Well ..._.�Ur..©_'`...............Foundation -__ ------_ Prop. Line --- ©........ _J LEACHING LINE No. of Lines _.. -. .----- Length of each line.._.8 ............. Total Length .._ ........ z'D' Box ...... Type Filter Material 4�� ..Depth Filter Material .....119. .............................10 Distance to nearest: Well eter �o�.FI...._Foundation �,:.. ............ Property line ........................ SEEPAGE PIT Depth '�_--. ---- ------ . Rack Filled Yes)d Na i❑ r ZL ., Water Table Depth --_...�r ....:�.....................Rock Size ....�.4.... .9--- �V' Distance to nearest: Well ...._4a��_r ....__._Foundation _... Prop. Line .......Z. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............ ..................... Septic Tank (Specify Requirementsl ...........................................................-.................•-•-- ........................---•--............... ....... Disposal Field (Specify Requirements) ---------------------------------------------------.---------------------- .......__ ------------------ -----------------------------------•---•---------------•---••-•----------- --------------- ----------------............... ---•... ....................................... .................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be [lone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrict. 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 bqxaMe sub'ect kman's Compensa ' laws of California." Signed _r-. ,� 1.C�C�L,S_�{_• __. �_(�lr By ----------------- ----------------------------------------- . _ _ .__- Title (If other than owner) --------------••---•------------ FOR DEPARTMENT YSEONLY APPLICATION ACCEPTED BY ------ -----------------------• �- t__._., DATE --Lc�. !.�r-.T-C. BIJIIDING PERMIT ISSUED ..._. --------------•----------••----------------- -- -•-- -- . L-11 DATE ADDITIONAL COMMENTS -------------------.._... ------•---••-------- ---------------•--------------------------------................................................................. - --------------•- ----------------................ •-------..._.... ------ --•-••--••-•--........... Finalinspection by: ................................. gate ...ID:/.5' � 13 24 J-6f3 Rev` SAN JOAQUIN LOCAL HEALTH STRICT 8/7h 3M