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FOR OFFICE USE: -- .. f APPLICATION FOR SANITATION PERMIT ---------- .............................. �Permit+Ao. ..7.7 :✓� (Complete in Triplicate) ......................................... _......... This Permit Expires 1 Year From Date Issued Date Issued . ..:��-.Z. 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. 549 and existing Rules and Regulations: c. .._....._................CENSUS TRACT JOB ADDRESS/LOCAI'SON ......_. ...+.. _...4-....._.....}.-------��- �•-•- •--------. . J d u I r -• - Phone._ .....l ' �� Owner's Name .__.....- r-C.S........ ..........I... --- -•---.........._......--------------- _-.-..._....- ---- ....... ..---•- i ...... ... City ..................................... ......... ...... ----------- _ , Contractor's Name ...........D•Leh:f-y*�.................................... ---.............License # -------_: ............. Phone .............................. I Installation will serve: Residence 0 Apartment House 0 Commercial ❑Traller Court 0 Motel ❑Other .......................--.................... i 2 S9 X �¢ ) Numbb�r, of living units:.._.R.._-.. Number of bedro ms ....3......Garbage Grinder _A ... Lot Size ....................................... :;..: Wateroy ply: Public Syste am am nd name ------ C?,_ (-�'-----..-W_-- ----�-------------------•-----...........-•- ••-- -----Private ❑ Character of sail to a depth of 3 feet Sand❑ Silt❑ -Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe� Fill Material ___.__._._ If yes,type ____________________________ vl (Plot plan, showing size of lot, locatiori-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 200 feet,} PACKAGE TREAT ENT [ SEPTIC SANK Ij Size`s :. !d n_ _�.l......._. Liquid Depth .........................• ,Q L Capacity ...._ Material...................... No. Compartments .._:...___... f P Y • TYpe :_....... ....:.... , { Distance to .nearest: Well .. � .................. .�eFo Foundation n _Q....• Total Lenop.th Line ...................... ._.....••.:.... LEACHING LINE No. of Lines _..__..._-?_!P-____ Length of }ch Ii A 9 Y Length -•--••••-••-• 'D' Box __ -It __._ Type Filter Mdterial��' _Z..LfgDepth Filter Material .....A9.................. . .. Distance to nearest: Well ..,�J:i +.e...... Foundation _.._..... Property Line -- .t..:�... c�E � f It SEEPAGE PIT Depth ..._.. Diameter � .. Number Rock Filled Yes C] No C1• Water Table Depth ..Rock Size ..........-•-----•---•• ... Distance to nearest: Well ............................... ...Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ....:... .................. ____ '.f Date ) I �. Septic Tank (Specify Requirements) .................... .. ..... --------------- ` Disposal Field (Specify rRegiriremeuts) -- ...,.. -------------------------•-----------•------- ------...----.._.... ................... I 1 . ......... .... ............. ................................. .........-•' .• --. ------•--------- ..... ',(Draw existing and.required additio4 on reverse side) 1 hereby certify that I have preparedthis applic tion and thatifhe workhe' will- be done in}accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of tSoW.loaquin Local Health Distric!`Home owner or licen- sed gents 'gn"' a certifies the following: I P^ "I ertify th t in the perform nce of the work for which this permit is issued, I shall Rot employ any person in such manner as beco a subject to Wor man's Compensationtlaws of California."I Vk6 F Signe Owner 1 A b BY ....................... ...... 1 Title --------................................................................ I i� (If other than owner) {4 V, q%--OO <4h 6 _ OR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY ... I DATE-.,..--- -- - .- ...... c BUILDING--PERMIT ISSUED. - ..DATE :.... ...... ....... ADDITIONAL COMMENTS ................................ . ............-•••-••-..--- -- ..--•.--• ....-•---•--......._......_._..----....._......... • ._.. Final Inspection by . .........................................Date SAN JOAQUIN LOCAL HEALTH. DISTRICT ze r 14 13 24 1_,AA o. SAA 7172 3 M ,