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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -.Z7-.414`� --- -...:.-----------•'------------------------------ (Complete in Triplicate) - ............... ------••.... ........... . ........- -- Date Issued 11Z1:& This Permit Expires 1 Year From 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: r o g`13 0 VA1 /�G t JOB ADDRESS/LOCATION .Ix2 - '- "'-UST CT --- -- - Owner's Name aei a--4L - ................ - Phone - -. Address ----------�0 DOS. r�.-. .... ... . . . - _-- City Contractor's Name ....(—, cwJ `�'. --i- ""--- License # I��;3 Y-- - Phone .............................. Installation will serve: Residence Apartment Ho yse Commercial Trailer Court 0 Motel ❑Other. -9e[rn�f9 Number of living units------------- Number of bedrooms .--....---.-Garbage Grinder .......--..- Lot Size .--------------.................--.-------_-- Water Supply: Public System and name -----------------------............................. - ...........-----....... ........................-_Private [ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat l' 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: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK fpf Size4. .X-_1..4_--X..S----------------- Liquid Depth .............. Capacity a- Q L' Type ; ,-- Material-ce(/I�---------- No. Compartments - ..:_I--..-..._ . !!// Distance to nearest: Well �t.-----.I ____________Foundation -----LfQ_----.----. Prop. Line r ��[ ] No. of Lines ........ 1.....---.:Length of each line.........L 41. . .... Total Length o U--•----- lO�G 'D' Box ..tj------ Type Filter Material .---..Depth Filter Material -----..--.I9. .............._...._ i O® �/ Distance to nearest: Well ...._...L.Qn---__-- Foundation ....S _._---..__-. Property Line .:5............-... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .--........-----.--......... Rock Filled Yes ❑ No Water Table Depth ............ ...................................Rock Size ---- - ----- ----------•---- Distance to nearest: Well ........................- -----------Foundation -- -------- Prop. -Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................-----------------1< T;..: Septic Tank (Specify Requirements)"':...7.4 -_- `•----.r.,.•••-_....------------------ --^................... ..:.:-..........,.------ ---............ Disposal Field S(Specify Requirements)"••"=---=--=-=-�--==-�-.........---------------•"-' - ............ ...........:------•- - ... - ----------------- t 4I !tI ; [Draw existing and required addition on reverse side) , I hereby certify that•1•ftave 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: - - .._ _.. _ - _- . "1 certify that in the performance of the work for which this permit is issued, 1 shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner -- - - - - - ---- - J F '. Title tTA 4 . (If other than owner) - _ - FOR`DEPARTMENT'LISE-ONLY— APPLICATION ACCEPTED BY - .,fir-7. - --------------------••- --------............................. DATE . --Z 7- ----------- BUILDINGPERMIT ISSUED .........................-......... "-'------....----.....----------............----•-------. ....DATE ------- -........................ . - ADDITIONAL COMMENTS ---------------------------------------------------------- -- - - .......................................... ...... in Inspection by: --........ - - -�'--�--. :.-----....- --------------- -----------•------.--------....Date -...,/'�...._.l ..-. . SAN JOAQUIN LOCAL HEALTH DISTRICT )