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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...75:.-5��•-�• _...........................:....................... (Complete in Triplicate) _................... ....... �. �.,� s+ �„ Date Issued . .-. '"`This Permifgxpires-1 Year From Date Issued and l the Work it to A plication► is hereby madteiso d�°n tomplianc Local wi hHealth Cou tyt0 dinar a rict for a No, 544 and ex sting Rulestalnd Regulations: rein described. This applicatia 3_ __._. :, i4..P...... J08 ADDRESS%LOCATI Nh T A ...... �.. . ... _.. _. k .. l/. . . r -_ t r`s Name " Owne rcJ..-- .. , .. �¢`�.0. .: ........ Address -- ofv.ES.__�.. ...... ................ City _ .� Phone � 4 ' _.License aS :y- .�._.... 1Contrattor's Name } t ' Elnstailatiori will serve: Residence Apartment House Q Commercial Trailer Court `] -Mote) 0 Other- ------------------------------------- 4 ,Number of living units.,............ :Nurnber,.of bedrooms .............Garbage Grinder ------------- Lest Size .a.a--- • •-GA S ,Water Supply.. Public System and name --_----„-:--;-................... .. ... .. Private ❑ Character of soil to a depth of 3 feet: Sande . Silt-�d Clay j]Y Peat❑ Sandy Loam fl Clay Loam f. , Hardpan ❑ Adobe {] Fill Material'--_:_Y._.:: PLY -,type'... -43";...---••---------•• -. Plot plan, showing size of, lot, location of;syste ;�etc.t must be pl m in relation to wells, hviidings dced on reverse side. ,-.,NEW INSTALLATION: (No septic:tank or seepage pit-germitted'i# pvb�ic"sewer is ava�able within'200 feet, � . PACKAGE TREATMENT. .(,J SEPTIC TtNK � ) a," Si xe._.__... --------------;............ ...... Liquid Depth ...... r, No Compartments ................... • � - --- Material...................... . Capacity �.. _ Type Pr n ............... ... -.- s -, Distance to nearest; Well ------------- ...----..._Foundation ...........,._. _.--:. op. Line l § No. of Lines ........................ Length each line Fdte Total Lengtith jt LEACHING LINE D' 'Box ..:_.....'.... T e Filter Material r Material ` •----- Foundation _....................... Property Line ........................ }� Distance to nearest: Well ...:-.--_-- SEEPAGE PIT'S O Depth ._:'.............:...' Diameter :...----..-_..-• Number ............._.... ' Rock Filled Yes [] . No EP Water Table Depth •-•---•-- ........Rock Size .........................-...... l Distance to.nearest:Well --------------- ------Foundation __._..------••---•-- Prop. Line ---•--------._.._..... j REPAIR/ADDITION(Prev. Sanitation Permit W -•--••-•--- Date q�,�,,� .................. Septic Tank (Specify Requirements) _.C.D- - - d"'• " Disposal Field (Specify Requirements) ----- ............................. •-----. _.....---------•- _ -_,X---- (Draw existing and require addition on reverse side) ' I hereby certify these I have preparedthis 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 1icen- k sed agents signature certifies the following: "I certify that in the performance of t1 .1he work far which this permit is issued, I shall not employ any person In suck manner i as to become subject to Workman's Compensation laws of California." ' ` Signed --_.__. ........................ ------.-•-••. :....----.. ........ Owner / �aP R i .r.F 0 - ---- ........................ ......._ 4. ...:..:.......... Title 4. ..Q _ .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTf D BY ... --- -_---------••- .......... DATE ~� .................... BUILDING PERMIT ISSUED .. --- DATE ...... ........ ............ ADDITIONAL COMMENTS .......--•----•-=------..._....................................••--....._.._......__. Y...------- -... ..... ...............I.... -� ..._. ... --. .. :_" _ ................ ....-- . .....----- . .......... ............................. ...:. .........................................................................................._.......Date _._.. Q 1,.. .... .....•.....__.........................................I. ...-• Q,.. . I Final Inspection:by: ....: �C. . f-��-•� ' �l + —'.SAN JOAQUIN:LOCAL HEALTH DISTRICT _ .. , 11 �.. 7172 3.:M— '1 9