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FOR OFFICE iJS5 " APPLICATION FOR SANITATION PERMIT ......................... ..-----: -- � Permit No. (Complete in Triplicate) � --• .►Date lssued-!�4.-7rf?/-2.t__...._.._.._..___.....................................�. This Permit Expires f Year From Date Issued r 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 _.� ._1... ..-.f.1_+ �.1. /.... : :Cf.- .J_.---•_.--..._..._CENSUS TRACT ....... ............. . .. Owner's Name ------------------- ...._..l.... / _ .-•-•-----------... ...........------.....Phone '?Address ._'---------------- e . z�?7._ _._ _ `....-..---- ------- ......... City �----C�1-----......_....._....--------------- Contractors Name ................ .d9kP-L�f .. �? ?, ._. t G._...License # ------------------------ Phone . _�n� &2., Installation will serve: :u Residence %Apartment House❑ Commercial ❑Trailer Court 0 I Motel ❑Other------------------------------- .......... Number of living units:.:.. __ .. Number of bedrooms ____...Garbage Grinder ............. Lot Size .c5 .......:... i x Water Supply: Public Systemend name .......................... ............................ ....................................Private I Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam [] . Clay Loam P Hardpan E] Adobe Fill Material ------------ If yes, type ............................. i {Plot plan, showing size of lot, location of system in relation tc 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 TREATMENT { l SEPTiC TAN KI ] Size............... ...........:..................... Liquid Depth ....................... Capacity Type ..................Material---------------------- No. Compartments ............. ......._ 4 Distance to nearest: Well ...................................Foundation ...................... Prop. Line .....................�✓ LEACHING LINE [ ] No. of Lines -..:. Length of each line------------------------ Total Length .....I................ 'D' Box ............ Type Filter Material ....................Depth Filter Material .......... ] ] Disttdnce to nearest: Well ------------------------ Foundation ....""__._. ............ Property Line ........................ SEEPAGE PIT Depth -------------------- Diameter ................ Number ............................................................ ---_.. ._ Rock Filled. Yes ❑WatJNa Rock Size . � Table Depth'.................................................. Distance to nearest: Welt ---------------•- ......................Foundation ..................... Prop. Line ....................... , REPAIR/ADDITION(Prev. Sanitation Permit# —._...._..............:................... Date .........................._:------I e m Septic Tank (Specify Requirements) I ................. ..........----•- -- Disposal Field (Specif Requirements) ;� . ? ?9 �� i�'' .....f.ll' �f_7_ � .................................... GZcrs..?._ ...-- --------------------------- (Draw existifig onci�Qequired dddition on reverse side) i 11 hereby certify that 1 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: ` f "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 betc me subject man's Campo laws of California." rSignet � ..�._. .. ..RL .K .. -��QfL.S ,a # .... Owner BY -------- -----. .- ..... .... --------- ........ .Title ...... ....... --.-_- (if other than owner) j r_OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYY' ------------ --------_... .....µ---- _ -�-'---- ----� --------------- DATE._-..-h"--L . �� ..p .... ......-.."...........DATE ......... ........ ... ' ................ ADDIDTIONAL COING IMMENTSD- ._�P=c _.QAC -- - �- L�------------------- .......... . .. ....... ..... ..__ . .....--"---------..._....-.----- -. ............------------------....----..._.._.._......_......... .....-----•-- ............. -_... .. . } Final inspection by! -----------•--- •--------•----- ...................:....... ....... .........• ..:............Date ._ SAN JOAQUIN LOCAL HEALTH DISTRICT -� r r,� ` 0 j -G-t4_13 24