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t.. FOR OFFICE`USE, FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7d c ' ,v - -------- ---�-------- -- ----- --- Permit No. /lJr J..� t rx -'�� I ) (Complete in Triplicate) ------------------------rte----- ----------- ? Date Issued../-_^3__9g ' ------------------------------------------ ----------- -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and.install the work herein described. t This application is made in co!m lI' C9�mty Ordinance No. 549 and existing Rules and Regulations: ; JOB ADDRESS/LOCATION. / r'.�1 _CENSUS TRACT: --- �O ----- --------Phone- - - wner's Name----------- . �, .GLlC-1 -- C -� Address-- --- ------- -------- . = ----4------ -` ` ' City ��i•' -------------- ZiP-----� Contractor's Namy, �'� � > - License #. - ane- JJ'/ pj t7 G Installation will serve: . esidence'. Ap tment House ❑ �omme ial Trailer Court ❑ 4 Motel ❑ Other--- ------------- --------------------- ---- Number of living units:-.1___i ----Number of bedrooms.�----Garbage Grinder------------Lot Size_-- �`� 'e-------------------- Water Supply: Public System and name--- -------------- ------------------------- - Private i Character of soil to a depth of 3 feet: Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam' + Hardpan ❑ `CAdobe ❑ Fill Material____.........If yes, type .--._-..__.___---. F (Plot plan, showing size-of lot, location f system in relation to wells, buildings, etc. must be placed on reverse side.) f NEW INSTAL'LATION;. '�e-p • ank or seepage pit permitted if public sewer is available within 200 feet,) �� X% �'"f�[No se filch t f` R �` PACKAGE [�] SEPTIC'.TANK [C] Size-____-. _C -----. -1==------------Liquid'Depth._C�_ -______ .-_ PA ,� 6 �,.. Capacity/ .. _ Type. 0' � Nlatc+riak_ .�C''/`% -No. Compartments__.... ____, i .- #,_lk Distance to-n a esti Well.----l`��--- Foundati�-----�? Prop.- Lin f LEACHING LINE. [ ] No`of Lin s ,"-. ---------- Length of each line__ __ .l'.'�--------------Total Lengtdh--_-._�r�C-��._,,_ __.-_-_--.�— ry '__Ty0e Filter-Material Filter Material____...p�C __..- ---------------- -Real , s- • _ .� ,,�" ,i � . . --- --.. Distance to nearest: Well,_.-__. _- E �d Foundation - = Property Line-- I SEEPAGE PIT [ ]-dry Depth . __ Diameter.. ` _Number__....-._ .............__ ��Rock Filled Yes❑ No ❑ Water Tablet Depth- ;_' ----------------------------------------Rock Size------ ---��Z-------------------------------- ,1 -� Distance-to'nearest: Well-------------------------------------------Foundation--------------- ----.Prop. Line---------------------------- �... REPAIR/ADDITION {:Preva Sanitation.Permit#----------------- ------------------------------ ____-------- - ---- - - -- -----------=-------Date -------------------- -------- -------] Se D ie TonkI(Specif quirements] i f— = --- ---------------- --------- DisposalField (Specify Requirements)':----------• ------- ------- ----------------------------------------------------------------------- ------------------- --- ------------ W 4.Ei ----------------------------------.. - --- t__---.--------------------------------_-----------------------------------------------r-__.-------- -----_.......__._____....�____-.__..___.__.__..._._______ ---------------------------- _____--------.F._. _________...-------- ------ ---------- ------__-------------------_---_----------------- ..__---------------------___------------ j (Draw existing and required addition on reverse side] 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 licensed agents signature certifies the following: "Icertiifyfti�at: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." i Signed---- -------------------------- ---- - -------------- -- `----------------- -- ----Owner jet - �� "1 -----------------Title (If ther than owrier[ r FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY ----------- - DATE. +-��` i DIVISION OF LAND NUMBER ---------- - ------------------------ ------ ------DATE-=---------- ------------ --------------------- ---------- ------------------------------ ADDITIONAL COMMENTS-- ----------------------- --------- ---------------------------------------------------------------------------------------------------------------- .................!./...�! = ______�__`______-______=______________________________________________________f_._._ ___._---____-- --------------------- -- __________ ... -- - -- ..................... _.___ ----_ CY..._ _ __________________________ ______ ------- ----Date-- /--Final Inspection --- -------------- EH 13 24 SAN JOA UIN LOCAL HEALTH DISTRICT ras 21 zp'7 e /7b 3M