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"- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. _. .. ._.__ ._. ..7T...!.: .. (Complete in Triplicate) Permit No. :, ...._ ._......._.._._...... . ....... ...] This Permit Expires Year From Date Issued Date Issued Application is hereby modr, to the San Joaquin Lccal Heal!h District for a permit ''to construct and install the work herein described. This application is made in compliance with County Ordinance No. Seg and existing Rules and Regulations: may/ � y i JOB ADDRESS/LOCATI �_.OX .7.. /r /.r-�!l ^ 4...A- CENSUS TRACT .......................... Owner's Nome .. N G.<Ga-Gtr ...... ....... Phone . ..... .................._... Address 222. .7.. .� `t^' ✓y-.-.........Yz �'� ..... City `-r_J.. _. ... ............................_. ... _ .... Contractor's Nome .. ..... �....' -.N.`'............ ...License # ��g��.by.. Phone .. ......................... Installation will serve: ResidenctBApartment House 0 Commercial ❑Troller Court ❑ Motel ❑Other........................................_.. ' Number of livingunits:.... .-..... Number of bedrooms ......Garbage Grinder .. .._..-.. Lot Size ..:...:. .">•.R'...... - � .3 Water Supply: Public System and name ............................................... ---_-----.-------------------- ._.. ...._.....-...Pr(vate i.. Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat C] .....-.Sandy Loam Cloy Loam [] �t Hardpan ❑ Adobe ❑ Fill Material _..._.--..If yes,type............................ Q - (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[ ] Size................................................ Liquid Depth .......................... \ Capacity ..-.._.__...-.... Type .... ...... .... Material------------ ........ No. Compartments ..................._. Distance to nearest: Well ..........- ....................... ---------------------- Prop. Line......................t� LEACHING LINE [ ] No. of Lines . ......._._._....... Length of each line..._.__...._........... Total Length ........................... 1 'D' Box ._... .... Type Filter Material .............. .....Depth Filter Material .... ...................................... Distance to nearest: Wolff ........................ Foundation ._.-....._._......... Property Line p ........................ SEEPAGE PIT [ ) Depth Diameter Number ............. Rock Filled Yes ❑ No Q WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Well . .....Foundation .................... Prop. Line �q REPAIR/ADDITION(Prey. Sanitation Permit# .......... Date .................................) Septic Tank (Specify Requirements) ......._ .........-..._..........................-._........................_._. .. ...... . ._...__...... Disposal Field (Specify Requirements) !�-'f--s..•=.'�"' Lr'..-e "—` - ------„/ .. .y-rs-g_ .�U--....... -� IDfaW ex+sting and required addition on reverse sidel I hereby certify that t have prepared this application and that the work will be dens in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regufallons of the Son Joaquin Local Health District Nome owner or Ileen- sed agents signature certifies the following: "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 become subject to Workman's Compensation Faws of Cafifomin.” Signet .... .__ ___. ... � ..- \ r.. .... .. Ow 6 _ . ............ . ��"�.- � . �-: .\� o-.f=1nP P Title ".-A\. l- ✓C.�- Y1 . _..... _ ......... (if other than owner) - FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY..................._..__........_................._........__.........._.................... DATE ......................................-..... BUILDINGPERMIT ISSUED ............. ..... _-....-.._......._.._.._._.................. ................ ............. ...DATE ........................................... '+ ADDITIONAL COMMENTS-..... _..............._._.............. ..._..............._-.........._.__......- ..---------...._................................................. i ...........................__........_..... ..... ............-_._...__..... ...........................-_,_......................... ...... ............... ............. ............... .__..___ ._._.._...._ .....__.._._...-..__.................. ............_.................... ........._............ ....................................... .................... .: . _.. __._.._-......_........_........._......._.._ _ _ .............._._.. ,................. ............. ... ' Final Inspection b ............... ....................Date -__. ................._................ SAN JOAQUIN LOCAL HEALTH DISTRICT s 13 24 7/723