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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �L, ZI - SCANNED Permit No. -'T�-'1;/� (Complete in Triplicate) -• _ _.........-... .................... . . ._.----.....---....__..... This Permit Expires 1 Yew From Date Issued 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION �.G.1- '----<� ----`- - `�------ ------- ------- -----CENSUS TRACT . .................... �y�/j ° Owner's Name -;4.. {f f - -- ------Phone ------------- ----•------------- Address _t_�-_ .dl�...... 4 ' . • Cy ---- — ----•_-------------------------------_- Contractor's Name - - Gt�}�r�.., lJ� '...........License # ._f 1F3Fy Phone ------------------ installation - — instaliation will serve: Residence©Apartment House Commercial❑TroihtrCourt 0 Motel ❑Other 1 Number of living units:-------!_--- Number of bedrooms -___Garbage Grinder -----.------ lot Size -- C1f2.E6y -_--__-- Water Supply: Public System and name -------—----—_.-----.--------------------------•-------_------------___..____Privc"er_ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam ff" Clay Loam❑ Hardpan❑ Adobe❑ Fill 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 TREATMENT [ ) SEPTIC TANK f-f Size--- _[l./G----- - ------ Liquid Depth m - • , Capacity -1-16"..--.-.-- Type _.•_ - Materiol. n la.-. No. Compartments _..rZ.� ....._._. .1 Distance S J Distonce to nearest: Well -.----_.-.�-cz.—---—-------Foundation....../_.E!..._-...... Prop. line_.._.___.._.._. .,J LEACHING LINE [/J No- of Lines -----------3------- Length of each line---------�F _____ Total length ...L2 . O ef A7 'D' Box -- ..._. Type Filter Material ._.. --.--Depth Filter Material .....?�/ _.............._....---.- Distance to nearest: Well ..._..1rQ` __ Foundation -------1�1. ....._ Property Line -_151 ... ._. IT! SEEPAGE PIT [yf Depth --- .-:�-.r._. Diameter -_7' �.. Number --------- X_:-------- --- Rock Filled Yes a No p Z_& ., Water Table Depth ............. ©_-•--•---..............Rock Sfze _._E _. --`-- Distance to nearest: Well ---.__ P.p -- Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ..............._....------•_-_----.------- Date ..._..—....... Septic Tank (Specify Requirements) ---------------—..........._........................................_...._.......-•-----....._._--...-.-.-.-.............._..../L Disposal Field (Specify Requirements) ............ e ......... . ......................... ---------------------------------------- ...-----------•-•-•-•-•-------- ---------------------- ----- ------------------- -- - -" ----------------------------- ------------------------------------------ ------------------------------------- ------------� (Draw existing and required addition on reverse side) 1 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. Nome owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, ( shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed __ --------- ------------ ----------------- Owner By -. . - --------------------------- - 9 '� -- ------ - Jitle ...tc '!t ---------------...----...--------------- (if other than owner) FOR DEPARTMEKF USE ONLY APPLICATION ACCEPTED BY - -- - - — - ----- — — — -----------_----.... DATE - f - � T _te.t.._. ........... . � ILDING PERMIT ISSUED -_-_-.._......DATE .. .. ..........-... DITIONAL COMMENTS ( e� .. _ _ ..--. .._ - _ -------------_......................car....- -- ---------------------•------------------------- ---------=-----------------•-- ----- -----------— -------------------------------------......--- ----------------------------------•----- - — - — - - --•-- - Final Inspection b -r•- -=-------- --------------------_ .... ..._ .. . .._ � .i: . ...-----.. --- -- -- --- ' y° ..---•-•. . _Date ...._. . SAN JOAQUiN LOCAL HEALTH DISTRICT