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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..7 - - - (Complete In Triplicate) - ---.. ------ This Permit Expires 1 Year From Date Issued Date Issued ..It......... 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. 549 on a 'stieg Rules and Regulatipns: -JOB ADDRESS/LOCATION �� . _-.(.Y. X � G(/ ......__ .._CENSUS RACTT ................�_(..........._ _ _ ... . ... Owner's Name . ....-GC,/.45-rr.Srf.S1.- . . . ..........Phone . . ........... .��oN.7tvc� ..... ......... . �(� __ _ �y-� ........ City : "sa"Wphk---_ ....................... .............. D �. lTg lr!Y.C,.. _.. License # ...-.. .. '.!T?.47-f-(o-.`.i Contractor's Name ,er21�tE-Jor�r.. Phone . nstallation will serve: Residence. Aportment House Commercial ❑Trailer Court ❑ Motel ❑Other . . .... .... ............ . ... . . . Number of living units:. G �_. - Number of bedrooms .-..-.Garboge Grinder . Lot Size .._/ ................................. _Nater Supply; Public System and name _.. ........ ...._._.... ---.............. ...._._..-..............- ..... -------..........---.Private � C' Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loom ❑ 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.) iEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'PACKAGE TREATMENT [ ] SEPTIC TANK I ] lejog/ Size......................... ... .__.-. Liquid Depth .. .. ................... Capacity .. Type -. - ._.._.. Material...... . . . _.. No. Compartments ...................... _ Distance to nearest: Well . ... .................Foundation . _. -_.. Prop. Line _..... .......... LEACHING LINE [ ] No. of Lines . Length of each line _..... _ ._ - . Total Length .. . _...................... 'D' Box Type Filter Material ... ................Depth Filter Material ... _. .................. . Distance to nearest: Well ... ... .............. Foundation _..-....-. Property Line `V SEEPAGE PIT ( ] Depth ___ Diameter . .............. Number Rock Filled Yes ❑ No 0 Water Table Depth . ..........................._....Rock Size ............. Distance to nearest: Well ........................Foundation .._ .._ . ..... Prop. Line ...................... :EPAIR/ADDITION(Prey. Sanitation Permit# _. ........ ._.............:.... Date ................................. Septic Tank (Specify Requirements[ ''�- 7�LS 7`F..fq........................-. .... .._.-----.•.-........ _........ .._.._....... ....- Disposal Field (Specify Re uirements) - �-- 'd>s"'�- -------fO.�� 4 . .. �r . .�-�.�s -�-.w.. f.±—...... . LIr _ t _ .. .. ... ..... _.... .. ...... to _ ... . . . -... .. .._ . (Draw existing and required addition a versfb a side) 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 Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1 certify that in t,,,h///BBB777 performance of the work for which this permit is issued, I shall not employ any person in such manner vs to became subj^,t�to rWqorkma s Comlpensation laws of California." Signed /NA✓11.. ��1�LG0 .47 r _._ .... . . . .. .. _ Jitl , �. .. '— (If other than owner) DEPARTMENT USE ONLY _PPLICATION ACCEPTED BY DATE BUILDING PERMIT ISSUED _ A..®® � - . . DATE - ADDITIONAL COMMENTS .. . r 4(x-- ..... ___ . .......................... ..-. .. .. .... . . ......... . -........ .......... . ......... ...... . ................. Final Inspection by. . ...... . ... .... .. .. .... . .. .Date lC-CS' ............. SAN JOAQIIN:AOCAL-HEALTH DI$TRRKT