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i FOR OFFICE USE: FOR OFFICE USE: 7• #,.,LICATION FOR SANITATION PERMIT _001 . .._.. ._ I' 30r Permit No. (Complete in Triplicate) - Date Issued / —......... _ This Permit Expires 1 Year From Date Issued Plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549 and existing Rules and Re 1 Ions: )B ADDRESS/LOCATION / L .�.._ _ �-�2 ,._ =--.-- _ _ .. ��.f. C.. CENSUS• RFt TCT __ Y �--� cam. , 1 / ner's Name T �� . . - _ _ __ _ Phone _ _ _ . . ..... dress. - z. ..Zi l .3 e L'1�. ��r c)Z - City- p itractor's Name / [ _71{� /11�:�1. LG'�:Knt _._. .. License # C��LI Phone—allation will serve: Residence AparmHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ... ..... _ . . .... -nber of living units: / _-_-. Number of bedrooms _ _ Garbage Grinder _ ..Lot Size ater Supply: Public System and name ----- ------ -- _ _ ........ ---- ----- .__.__....... . _ _ --- _.. - _ _. ....Private --iracter of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .. ...If yes, type .......... .. ......... .. - lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'TCKAGE TREATMENT [ ] SEPTIC TANK [ J Size L . . .- C ___ .....Liquid Depth ' Capacity . 0(2. .Type _ - Material__ ] _ No. Compartments . � Distance to nearest: Well � �. -. ---------_. -Foundation . .l C .-. - .. Prop. Line l ,� ACHING LINE [ J No. of Lines _. - _. Length of each line �. g _�� _Total length C? 00 • 'D' Box _./__Type Filter Material _/ _ _ Depth Filter Material. ... Distan o nearest: Well_ .- .. .-...Foundation .. .-_... 9 (.. �. !�� ...Property Line ... [ ] Dep )l�3iaTneter�� ....Number -.-- . ------------ // l Rock Filled Ye-s'l No ❑Z Water Table Depth........ _... .. . . . . . . ........... __--.. Rock Size . _ l Distance to nearest: Well. .. ......... .......--------- Foundation . . .__. .... _ Prop. Line 'AIR/ADDITION (Prev. Sanitation Permit# . . _ .. ................. .... ._. ...Date ,ptic Tank (Specify Requirements). . ..._... ... _ - --- ----------- ----- -------------------- -- -- -- ------ - isposal Field (Specify Requirements) ........ ... . --- ........... ----- ---------------- --- - - ---- - ----.. .... . _ . ----- . .- - ---- -- - - --- - -- - ----- ----- ----- -------- -------------- --- - _._.... ------ - - ------- --...--- ------- ..... -. (Draw existing and required addition on reverse side) _ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents -nature 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 > become subject to Workman's Compensation laws of California." Ined _ _ Owner Title /f/o2e t/an own % l OR DEPARTMENT USE ONLY DATE/� PPLICATION ACCEPTED BY ! ,IVISION OF LAND NUMBER _ __ DATE )DITTO AL COMMENTS �: ..........__... ...................._ . ..........._. .. .... -. . ... - --- -- ---------- _ - . _ . .. ... _ .-ial Inspection by: Date i - I'l 7A � CAAI Il1A/\IIIAI I/-1l'A1 IICAIT11 MICTMr-T FXS 71A77 OFV 7'7A IM