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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -n ��* ..............•--•-•-........ ;Complete in Triplicate( Permit No. .....-----•-•--_---- ........................... This Permit Expires 1 Year Front Date Issued Date lssued� 5... ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worfc,her®in described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRfSSJLOCATION _.Fl�v.�.c._`.1.rm..2'7..............................................CENSUS TRACT .......................... r Owner's Name .., F2EE'� i."_1T.1_ ?.If�I _.._......._ Phone' Address .;_... ..2. .--1n�4. &F F_ _2, D./y ,�r _. City o Contractor's Name .............TA, 14R� IYC... License _ � .. .� . .. Phone . ..;X.... Installation will serve: Residence JXAportment House f] Commercial❑Trailer Court ❑ IMotel ❑Other . Number of living units:..._:.--_- Number of bedrooms -......Garbage Grinder ............ Lot Size Water Supply: Public System and name --------- C .iE3-� C=. _�!!� T l .... '.l�s ...- .....private ❑ Character of sail to a depth of 3 feet: Sand❑ Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam r 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: (No septic tank or seepage pit permitted if public sewer is available within 260 feet,( PACKAGE TREATMENT ( j SEPTIC TAMC l Size. .......... Liquid Depth ........................... t Capacity I Type ------..--..-_--. Material------------- - ----- No. Compartments Distance :: nearest: Well ...... ... .........................Foundation ...................... Prop. Line ..............I.._....� f - LEACHING LINENo. of Lines ........... .•- ._.._.._- Length of each-lin-e.......................:.... Total Length ............................ l . 'D' Box .......... Type Filter Material ....................Depth Filter Material i Distance to nearest; Well ........................ Foundation ._.._._..... - --.......... Property Lute ........................ . } SEEPAGE PIT ( ) Depth Diameter ._. --_--..---- Number ............................ Rock Filled Yes ❑ No 0 . Water Table Depth ................................................Rock Size ........••••• Distance to nearest: Well ------------ ------------------_- ---..Foundation ._..._...._.... Pro Line ----- Prop. ._...... DITION(Prev. Sanitation Permit# ....................... ................. Date ....................... F R1 PAplR/A a } ► Septic Tank (Specify Requirements) "6/�!• -- ----....... ..................-................ ,.Disposal Field (Specify Requirements) 1 ---------------••----------------------------------------------------- ....... — ' ----------------•- ---------•-------------- ---------------------------------------- - `-- Q2•"-------•-- . raw existing and required addition on reverse side) 1 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 H"Ith:Dlstrict. Home owner or 11can- sed agents signature certifies the following: 1 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 come subl4Z_19 Workman's Compensation .taws of California." Signe -�-i l � 2 s oAtX TA!c . _►_ Owner SY Title— --� i_rr� C /� (If other than owner) •-- •-.---"'.•'- FOR DEPARTMENT :USE ONLY APPLICATION ACCEPTED BY- -- ------ ��-----•--- •-- _.. DATE Q-�. - ... _.. r BUILDING PERMIT ISSUED ............ ............ . .------------.DATE .............•-------- ,. . .......... ----------- -------------------------------------------------------- ADDITIONAL COMMENTS -----...........--- ----- . ---------------------- •-•-----•-=--- -•- -----• •------ - -------------•------------------ 1 final inspection by: ..._- -- -...- .._Dat i SAN JOAQUI LOCAL ALTH DISTRICT 8/7h 3M