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APPLICATION FOR SANITATION PERMIT .. .................... .11........... (Complete in Tripiicate) Permit No.Z.......��.0. . ........... . ... ...... This Permit Expires 1 Year From Date Issued bate Issued ./.d.`Z 2/ 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. 544 and existing Ruies:dnd Regulations: JOB ADDRESS/LOCATION �G I I nn fn ..CENSUS Te ........ Owner's Name .. . Phone ................................... -................ //gl Address � ................... � .. ,�/......f- 14,1'.Cp r� �•9/? City � Contractor's Name $' t `-- ......... . ....... .........................---.. G: G��C�FSI Z...................license #4�� .. Ph ane Installation will serves Resitlence E]Apartmentt Ho use�fl Commercial (]Trailer Court ❑ Motel ❑Other Number of living unitss . . . Number of bedrooms .... Garbage Grinder : Lot Size .... Water Supply, Public System and nome .............. . . .. ............. .. ........... ............Private ❑ Character of soil to a depth of 3 feet:I Sand V- Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ '\ Hardpan ❑ Adobe ❑ .'Fill Material ... If yes, type ., (Plot plan, showing size of lot, loco tion of system :n relation' to wells, buildings, etc. must be placedon reverse side.) N NEW INSTALLATION: . (No septic to k or seepage'pit permitted if public sewer is available within 200:feet,) PACKAGE TREATMENT ( ] SEPTIC TANK. ]. SIZO.......................... ......_....I..-..... . Liquid Depth __ Capacity -- Type .... .........: ... Material........ . . � ...... No. Compartments ....... --- Distance to nearest: Well .'... - ......... ...Foundation Prop. Linin ...................... LEACHINGLINE, No, of Lines „ � � . Length # each line ....- ..-.,Total length ................ . 1 'D' Box Type Filter Material Depth Filter Material ........_. .................... Distance to nearest: Well ................... Foundation ........ Property Line SEEPAGE PIT ( J Depth Diameter ... Nurinber .... Rock Filled Yes ❑ No Water Table Depth ..............:. .............................Rock Size Distance to nearest: Well .-....................:.................Foundation Prop. Lina REPAIR/ADDITION IPrgv. Sanitation Permit# ........ .... ........ :..... ._...... Date } .................................. t Septic Tank (Spetify,, Requirementsf;� 14C>0........ �4.14�..:.-..:.l-�4.��.'---. -•�IQ:��...U.L.....�.F.19.- - -.-, -•- Disposal Field (Specify Requirements) ./ .Jlr��...-.S.. C.! . . ............... .......... . ..... -- ..... .. ............. .. . . a --- .. ---.._.....---•- ......... (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 accordanc, with San Joaquin County Ordinances, SlIpte Laws, and 1Rules and Regulations of,-.the San Joaquin Local Health District. Home owner or licen- sed agents signature cgrtifies the following: "I certify that in the pfrformance of the work for which this permit is issued, I shall not e' mploy any person In such manner as to become sub'ect tp Workman's om nsation ws of California." Signed . .. .... Owner � f , a By -- ....................... Title r.. � f other than owner( - r_=..,�._-_,:-.. R DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ` �J.... . .. -. ... DATE . /0-- I-. . BUILDING PERMIT ISSUED . . DATE ADDITIONAL COMMENTS ---- ................. ................ ...... --•---. -. -"f. ..-.......... _. ...-.. _ ....... _.,.......... ._. ..... .. ... Final Inspection by. ...::... .Date ... I SAN JOAQUIN LOCAL, HEALTH DISTRICT