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*FOR OFFICE USE: Ii APPLICATION FOR SANITATION PERMIT ._..r_.........................` --------......--------- Permit No. .....,...... II '{Can+p� lete In Triplicate) .... ' ........ .. .................�---._....:_.._._....................... ....... li _ _. . »_. .. ._ _...��.._.. .,._.,.._ .......... ....:......... i This PernittExpires 1 Year From Onto Issued Date Issued Application is hereby made to the',San Joaquin Local Health District for a permit to construct and Instal) the work herein described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: - JOB ADDRIS .Q �. I�/LOC TON i Y LdJQ� , ........ ......................CENSUS TRACT" ......... ................ ,�. .q�.... ... . . �.l!.._ .. Owner's Name .. __..... �� Qx.�/.�! Ih J�F'!�a �.. .. 6................... Address ... .. . - ... ..... _ . City j . ..... = ,.�7. 3A......................... Contractor's Nome ... 0s2-�.....................................................License +# . ..................... Phone .............................. Installation will serve: Residence❑Apartment House 0 Commercial railer Court ❑ �IMotel ❑Other Num � WaterSupply!'Su f ing stem and name of bedrooms ............Garbage Grinder ............ Lot Size 174azg .....�.... .: 0 If Y i pp YID game ---•.....%.............................. .................»_,................... .... .......Private Character of soil to a depth of 3 feet:. Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ ' e- --� - Hardpan ❑ Adobe C] Fill Misterial ._.......... If yes,type ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.1 M NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) _ PACKAGE TREATMENT [ ] SEPTi�C TANK f I Size..::............................................ Liquid Depth .......................... !- Material..................Capacity ------------ Type -- Na. Compartments ........................J Distance.to nearest: Well ....................................Foundation .............. Prop. Line ...................... C LEACHING LINE [ ] No. of Lines ........................ Length of each line............................. Total Length ............................ 'D' Box ----.------. Type Filter Material ....................De.pth Filter Material ............................................ Distance tonearest: Well ...._ `__.........___.._ Foundation ........................ Property Line ........................ SEEPAGE PIT ! [ j Depth __111-------------- -------------- Diameter ................ Number ..---_-.-_..__............ Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ................................ p Distance toy nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sonitationld Permit# ............................................ Date ............................. .._..) Septic Tank IM(Specify Requirements) ------- --------------------------------•------•--- -•. Disposal Field ecif Require -------- am . ; ... . ---f..... a-t .._.,......s_ defrh �-...-.._. ............. --•• ----------- - -- . Jice,j' I _ _.. =- ____ ____ __ __ _ __ [(Draw existing and required addition on-reverse side) - ----------- I ' I 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. 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 become su ct to Workm �' Compensd ion laws.a alifornia." Signed = .-�- Owner it _ `` . - B II Title ................ ............ -- ..............._..'._........ Y ----...---- II�f other than owner) 1! s� PARTMENT .USE ONLY BUILDING PERMIT APPLICATION ACCEPTED 13Y - . . DATE .:: .: `1r........... ADDITIONAL COMMENTS _._...._ -- DATE MIT ISSUED --------- -- ...---- IM - •-------•-- -------- I�------ ------ --------------•-•-•----------------- ...................-............ ............ � .._.. Final Inspection by Date .... . ...:. .'�. _..� -... + EH 13 2It �I& I AN OAQUIN LOCAL" HEAILTA F DISTRICT B/7h 3M �I