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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - Permit No. (Complete in Triplicate) .�. ..:�_.. ........-----..............-..--.....-_...----.... pp .. ..........-. ._.._ This Permit Expires 1 Year From Date Issued Date Issued �9...—. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _sus ROB ADDRESS/LOCATION. ......-oar-fa-.u. ..- :....f X/a /Sd ,h .K ,�yy / p✓1-.. ._ /�tn. .t*h CENSUS. TRACL -wner's Name.... ._.-GU,. ',b .1,41ek rOfSL.. . ..... Phone- . . . --ddress ........... - . .6�g en - 7 -�Pn _ - - city........ .. ................. ........ Zip Contractor's Name __..._ ...''C'L.. -.._._-. -....-... .. License #...... ... ..... Phone. ........ ---- stallation will serve: Residence Ji7J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other... ... ........... . ........................ "umber of living units:_..._..-..Number of bedrooms...-- .. Garbage Grinder............Lot Size.__......... _ _- . ._- ---------------__.__ _ .. .ater Supply: Public System and name.. . ............ _.._................---Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam DR' Hardpan ❑ Adobe ❑ Fill Material.. .... ....If yes, type---------------- -- ............ Inot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) ''EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer i available within 200 feet,) � I� �\CKAGETREATMENT [ J SEPTIC TANK �(J Si,[ze_ __ _- .��i .-.. .-._-..._......._-._._Liquid Depth.._!V/4 Capacityf�D_.-_...Type/.A°ee.%/......Motor iaLeeh.CC[lee'...No. Compartments............... Distance to nearest: Well. 67,01"_. _- ----- - Foundation..... Prop. Line..... I_ 4- CACHING LINE ➢Q No. of Lines _ ......_.&�L..___... Length of each line.--------8 S.-_. ......Total Length . ..... ..... ..... ....... . 'D' Box__ ..-_.Type Filter Material 'r epth Filter Material_..-_.. .Ct.. ._......................___......_... Distanceto nearest: Well.....�Q(J ...Foundation---- .-__-..._.Property Line----- -.+..... iEEPAGE PIT $(IDepth..4ps __.Diameter..._..3 3-..-._.Number..-__..- P-----------._. -. ` Rock Filled Yes`,) ' No Water Table Depth................'.IRock Size...l..-.at___�1.i.c-..---.. .. Distance to nearest; Well...........1Sd..1+ ..-.._. ------Foundation...../.44._{ .. .....Prop. Line _.-S�t ..�.. ....._ '4PAIR/ADDITION (Prev. Sanitation Permit# ...-.............................. _.............Date............---_..... _ _.......---.-...-.1 tic Tank (Specify Requirements). ---- - Disposal Field (Specify Requirements).... ____------------ -------- ...._....__. _. ...___.._-......_._.- ----. ...-_.._ ......... ... ............. _.------..-............... ........ ........----.--...._ -........ ...... ......... ..-----_......._.. .._. __...... --...._...-__----.......... (Draw existing and required addition on reverse sidel hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County *Jrdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as 76 become poWect o Work t an mpensat' laws of California." 'Zi gned..._ ..._.....^..... ..... .........- -- ..............- .-._...Owner .?'.. ...... .......... ..........-------------------------------------- - ----_._.-...-._.Title_-.-....----- . .... .. (if other than owner) A FOR DE ARTMENT US O Y "PPLICATION ACCEPTED BY........ ..... .DATE ....- `? DIVISION OF LAND NUMBER. ._ . .-.. . tir1�. .. ... . -- .. . DATE. --..- - DDITIONAL COMMENTS Off- �\ L� ....................... ------ - -- .... . ........,,. - . ... .. �... iy�3 nal InsPectionr !� t V� 11- Date ?/ /-[.YRS 7H 13 s� - SAN JOAOUINILCAL HEALTH DISTRICT 2iaii sdv. me 3M