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E I r# ] FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .•3.�: No. _ �P (Complete in Triplicate) Permit ----• - ---••--- •--... .......... -------- -••- y Date Issued-.�:�0.--7.� 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. This application is made in compliance with,County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. _--.. 11. ._-.5. P-0i CENSUS TRACT---------------- ----- ----- - Owner's Name ...... y, ........ -- .. ---.:...-- Phone..-- ': NS.. - ----- Address---------- ---- - .. ... ��C A...- = City. ....._. .._ . ----------------- 'y Contractor's Name ..... ... . Ii. j. _...f11. � -.` OJ...... .........License #- .? _Phone-----------_--... -- ...... Installation will serve: 'Residence [r Apartment House ❑ _+ Commercial ❑ Trailer Court ❑ r Motel ❑ . Other-----.. g ,! rooms..-- -. _Garbage Grinder._1.0.._Lot Size.......&LQ..-X.�Q--_-- Number of living units:...-, _- _- Number of bed r ri- Water Supply: Public System and name. ae-Lb-c--s-�4� -- .-..Private ❑ Character of soil to a£depthof��3 feet-. .Silt❑ Cloy [] Peat ❑ Sandy Loam [] Clay Loam Ef. HardP�Z� "315eill`Material_....-------If yes, type------ -- - -_--- (Plot plan, showing size of lot, location 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 TREATMQU I ] SEPTIC TANK [ l Size.... ..........................'`�______._.--.. .. ..... __Liquid Depth.._.....-.. .... ........... Capacl .. ..... . ..Type--------- --- ----- material. xt � -.... ._.. . .........Pro rr - Distance to nearest; ------------------------------.-_- _ Foundation LEACHING LINE [ ] No, of Lines.,. 1� t � a Length . - f --- ----- - ---- ------- Len a ch lana ...-. g ------------ D' Box-. CR+~Type Filter Material_.1 r Material.. .....af ?. ..f'--. -X_1,0- .. t-d-...11! y Distance'to nearest: W ------------------- ---Foundation. ..:;_+_.. _ -.Property Line ......♦ = SEEPAGE PIT j ] De __.l�lumber.;.. .-, k Filled Yes ❑ No❑ ter............. J.,� �- •� -----=--------- -�-- •c - Water Table Depth �.... = ------`_:...t...Rock Size --..h.^ Z......(. Distance to nearest: Well.. ...... oun a 1on --..-....: o i REPAIR/ADDITION (Prev. Sanitation Permit#.......�'/ .3�` 991 ] - ----------- ------ -• -.. . ; -.Date- --......--- . . ......- ---- ------- Septic Tank (Specify Requirements) .......... ''.. `...«•- ----------------- . i Disposal Field (Specify Requirements)................... X-fO- la----. t ,�ss~ pF.JA1e�-- ' rV i - 4 -----•.................. ............... ....................�-------- -----'----'---.- ------ -------.-...-'-----------'-...................f.....--............-.-..........-------- --- --_-- {Drow existing and required addition on reverse side) I hereby certify that lihave 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: I "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----------- alifornia."Signed----------- ----- ---- ----------- ------------......--------Owner By .................... ......... ----------------------.-... .................-------- .... --- Title. .._.......------.....- (If other than owner( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ DATE ---------------- -- DIVISION OF LAND NUMBER... .......... ............. DATE:---.....-_....__......---.- ..-- - ,;-- --------------------------------------•---•---•---------------.•. ...-•----...-...-..- ADDITIONAL COMMENTS ..-.-..--- .._....... Yoh....-- _ ..-p -- ......._. --------------- --------- - -------------------------- -- - -----------•-------.....--------------....------....... _...............------------------------------ •-------- --- .............. •------ --- Final Insgecfion b ----------Date. ........ ......................... EH 13 24 SAN JOAQUIN LOCAL. HEALTH DISTRICT Fos 21677 REV. 7176 3M