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r 1 �,- �IEOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --Z-7 ------------------------------------------------ �. (Complete in Triplicate) •�' -------------------------------------------------------- Date Issued z� This Permit Expires 1 Year From Date issued Appiication is hereby made to the San Joaquin Local Health District for.of 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: . - CENSUS TRACT �- �-----• c c{$cS-� `1 ----------------- ----------------- - JOB ADDRESS/LOCAT ON _.-�--��-d//-� - - "=--� -- �- Owner's Name ---- ----- Gz Gs Phone - c tsn_- City,.-. � C ' Address ----- ------ - f --.Lite se # --------- -------------- Phone ------------------------------ Installat on will serve: Residence artment House❑ C ----------- -- omriiercial ❑Trailer Court ❑ i ' Motel ❑ Other. ------- -- ----------- g 12 �� Lo# Size 1-1 , --------------------------- M Number of living units:-4------- Number of bedroos>_--- _-.._Garbo a Grinder - Water Supply: Public System and name -------------- ------ ' y;- ;'---------------------- -----I------------------------------------------Private Character of soil to a depth of 3 feet: Stand-'Q Silt`❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [P- Hardpan E] Adobe ❑ Fill Material ------____-- If yes, type --------------- (Plot plan, showing size of'�Iot,, location of.system in'relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No,septictank or seepa a pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT { ] SEPTIC TANK [ �, ---�C-Y--,.5 -9-- -------- ------- Liquid Depth ------- - ----------- Size CapaatY 0011---- =TYPe� °l _ Materiai.C_dn�mck�f— !.,No. Compartments --2------------- q -Foundation .-/0-/------------ Prop. Line ----c�� ---------- \A Distance to�nearest Well ---70----------------- , la LEACHING LINE [i.�No, of Lines ,'3----------- ------ Length of each,line.__- C .....-.t.---_.-- Total Length --A.- �•---------- r` :` i� I D' Boy C�� __ Type f=ilter Material glat_/i-----------Depth 'Filter Material .____.--__� -----------•-- ---•-- Distance to-nearest: Well --------/ ____--- Foundation ..--�.�:..-__ Property tine .... ................ SEEPAGE PIT [ j Depth ('' Diameter ---------------- Number _.__.___-------------------- Rock Filled Yes ❑ No ._ water Table Depth--------- -----------•--------------- .. Rock Size - 'Distance to nearest: Well -------------------,- `� -_Foundation -------------- ---- Prop. Line --`-------- Date -----�----------------------------) REPAIRfADAITION(Prev. Sanitation Permit# -------------------------------------------- --- i Septic Tahk (Specify Requirements)'-------- ---------- - ------------------------------------- } Disposal `,Field (Specify Requirements) `' ------------------- ---------------------------------------- ----- - 1 - .- ' -------------------------------------- ------------------------ --------------------------------------- --- -- (Draw existing and required addition on reverse side) j 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\Jo�uiTLocal Health- istrict, ome owner or licen- sed agents signature certifies the following: l t I certify that in,the perfo rmance,of the work for which this permit is issued, I shall not employ.any person ih manner as to becomes ;ect ro an's�,n '- ow's of California."�Wokm �/ _OwnerSigned . - : - ------- - B ------- ---- ------------------------ r ------------------------ -----------j ; ------- Title ------------- - --- ---- ! - (If other than owner) - 'FOR DEPARTMENT USE-ONLY- APPLICATION ACCEPTED BY ------- - =---`----'-- '`- - -. DATE ----L_7--0r---�.~)` BUILDING PERMIT ISSUED -----------------------=---------------------------------------------------------------------- DATE - ------ ADDITIONALCOMMENTS ------------------------------------------------------------------•--------------- ------------------------------------- ------------ -. ------------------------------ -------------- - ------------------------------------------------------- 1 --- -------------------------- --------- --- -------- ----- -�- - -------=------- ------------ Date t-o-------------------- Final Inspection b ___ SAN JOAQUIN LOCAL HEALTH DISTRICT v u n 7 'L.4 De.. +SAA