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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � 7Z/—,V?7 J . .r.�C}.. .... .. .... (Complete in Triplicate) mit o. ..................... Date Issue .......... This Permit Expires 1 Year From Date Issued ................. i Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..................—CENSUS TRACT ......--.................. � Owner's Name --••-----•-• L�, �C"�..i1.GD.-y= �.�� / :.....................Pl7one . .�. �.�1........... Address ........................ A,e.e-,01_ 1 .0City ..................... ...................................................... Contractor's Name "G21-f,C.�Cf-----------------------•----.License # -- --�� 1- Phone .......s ._.._......-...... Installation will serve: Residence Apartment House❑ Commercial ❑Traller Court 0 � Motel ❑Other --•................................... ..... Number of living units:............ Number of bedrooms .--, ._...Garbage Grinder -------- lot Size ..... .ar1 .4---- ............. 1 I Water Supply: Public System and name .-------•------------•-------•.................•-----•---.....-------------------------•----------•...........Private Character of soil to a depth of 3 feet: Sand Silt Clay Peat Sand Loam Clay Loam P ❑ ❑ Y ❑ ❑ Y ❑• Y ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............................ w� (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK[ 1 Size...4X-�..X:�. ................. Liquid Depth .....cam.. ......----- � i 19Capacity lQ.r�....... Typer ..tcc.�1_... Material....4_� No. Compartments l ............. ad v Distance to nearest: Well ..................................Foundation .......................Prop. Line ...................... —0 00 LEACHING LINE [ ] ;No. of Lines __._._ ._ _ g �l i '�-----._..... Length of each line---------�--------------- Total Length .._.�.-�1�.._....•--... / _/ . 'D' Box ....11 Type Filter Material ....................Depth Filfer Maateriol ........-..• --•........•............... rn l ------ Distanceito nearest: Well ........................ Foundation .........44.1............ Property Line ........................ . SEEPAGE PIT [ ) Depth Diameter .. ?. .-.. Number ............-. ......... Rock Filled Yes No ❑ Water Table Depth __-- ...........Rock Size ......................... Distance to nearest: Well ......1.14�.........................Foundation .. ...... Prop. Line ...`4.2...... Q i REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .......•---------------........... ) i SepticTank )Specify Requirementsl --- ....................... .................................................--......................................_.-----•-----•---- J Disposal Field (Specify Requirements) ....................................................-------....----•--••--------------------------------•--------------- ._.......... I --------------------- - ------------------------------------------........................I.................................................................... (Draw 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 Health District. dome 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 - ---- ---------------------- ---- ,Title ..._ = ----•.-----.....__..._............... ...... By'-0E.4- i.•� T' (If other th owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... .. sree...: jC - --i.............................. DATE .... .-"- --?�_.�..' A .......... BUILDING PERMIT ISSUED ......... ...:.... ......................................................!..............................DATE ------................................... ADDITIONAL COMMENTS ...............................................:. .............................. .............. • •--- ------------------- ----------------------- ••....•• -- - - --- -----•---......__...........---- ------------------------------------ . ----- Final Inspection by: }. !. .........Dare .�' 1 c� j� SAN L HEALTH DISTRICT i E. H.13 241-'68 Rev. 5M T� 7/723m