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FOR OFFICE USE: PPLICATION FOR SANITATION PEr T _._ ........... `. Permit No. ..� -� .b --_-. .............................. (Complete in Triplicate) " •"".. .. ._......................................... .... This Permit Expires 1 Year From Date Issued Date Issued 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 and existing Rules and Regulations: `JOB ADDRESS/LOCATION ........ -"G'Ll., ... J. .. - .- --.-- , SUS TRACT .......................... Owner's Name ............. r ...... --........... .... �,�v�y .iL�✓t....rS..,.--- -- -- - ----- - .-..-....: ..............Phone .................................... Address _._.....%s---d•Q ........ -/...,e�� X./....`�/J- - r...... City .. ......................................... Contractor's Name ....4f: . . _ 4 AA.4w , _.License # -2,C.Z.et.F.- Phone Installation will serve: Residence ❑ Apartment House❑ mmerciai Trailer Court Motel XOther - -. 00, SID Number of living units:.��lumber of 6 rooms ..... ... G age Grinder _O"Tot Size ..� (:lir .` ----.. �fGf! ..-. ... —Water Supply: Public System and name .- - ------t ."'- -------------•-------------------------------—Private,"' Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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 pern*tted if public sewer is available within 200 feet,) `PACKAGE TREATMENT ( ] SEPTIC TANK[ Jj '1.r5iz � �1 .• t��.... Liquid Depth ...,Er..,r ................ Capacity .................. . Type .................... Material...................... No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..............._..... LEACHING LINE ( No, of Lines ./------------------ Length of each line... 9 aQ................. Total Length +�-Q.......-.........._. ` _D' Box . ...... Type Filter Material .. ...Depth Filter Material fsr�js4anee to nearest: Weill1QQ..-.. .._....- Foundation .G: ............... Property Line 5�--�....--.---. 44 i ,,/ s r SEEPAGI(PIT Depth a�......... Diameter4; l..--.----. Number ......... .....o.. ..... Rack Filled Yes,0 No ❑ Water Table Depth ........��..£...---�--........_.I.......Rock Size .....o[...:�: ............. \N Distance to nearest: Well ...1ollQ. _......--•-.--••---. .Foundation ----- .. . Prop. _ --.-.- ... LREPAIR/ADDITION(Prev. Sanitation Permit# .......... ....oot....., ------_--_--p- Date .-.-----..--.............----....-1 Septic Tank (Specify Requirements) ----- ..-. . .-.-- ....,oG---.......�s.- ,.C.�-.-_....��..Z..`_'�.. - Disposal Field (Speci Req mentsl ��Z'^ 4A..--. 1- k - L- / .. -------- __.......- _.... s....................... .. ............. .. .. ( w existing and required on on reverse LI 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 San Joaquin Local Health District. Home owner or licen- 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 laws of California." Signed ..-.. --- ----------------------- -------- Owner --By .. ..-. ....... Title .... qt (If other than owner FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... -------- ------------------_---..------ ..-.-----. DATE .......... .... ............----- ------ BUILDING PERMIT ISSUED ........ ........ . .L DATE .........--..... ADDITIONAL COMMENTS .:..lCrr. P.[AT�.1Q.._-... r ..-.... ......................... ._........................... . ................................. .. ................................. . . ............................................... ...... .............-- ....................-..-.... ---•-•------------------------ . Final Inspection y; - - .... ..............................................................................Date ..1 .-541 -. -..------ -- ` SAN JOAQUIN LOCAL HEALTH DISTRICT c „ 1.9 24,