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I ^ FOR OFFICE USE: U 1� APPLICATION FOR SANITATION PERMIT � ....... . .. ......... ... .. 1/...'fie......_ (Complete In Triplicatel Permit No. ... ... .. . ..... ..........._._.1.................----_- ------ ........ This Permit Expires 1 Year From Data Issued Date issued ............. . .. Application is hereby made to the;Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: I I JOB ADDRESS/LOCATION ......; �t�fJ�-----./S(Q TIt.._...,W �f..--.... .- I. ........ ...CENSUS TRACT -------- Owner's Name ..4f ............•.....................................Phone t Address ._�Gy16.Q....... iF±� IL. .... (r5�1!iCI - jF! . - /...p City ../Ci.' t/�. .�..�� ...... ---- -'--'-......-- I e 3/ Kf'fiT.. Li�A. -- , .SSW - C . . . . ........ Phone //---- 1 Contractor's Name . .ei1 ...a. _ � e"- A .....___0•License# -_...___;.. . . Installation will serve: Residence VAportment ouseo Commercial OTrailer Court 1] Motel ❑ Other... ........._ •-....._._............. . Number of living units:__.✓.t...... Number of bedrooms ... Grinder ............ Lot Size _. 5....................... iter Supply: Public System and name --_.-.....•--_--._--------........................._.._........................Private ❑ Character of soil to a depth of 3 felt: Sand j] Silt❑ Clay ❑ Peat❑ Sandy Loam Q 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.tonk or seepage pit permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTICTANK j ] `:„'•o�Size. >-.__��.......'.�._`..,.:.`.+..._. ..`�`,L(quid _ J Depth ................ ....._. Capacity------------- Type ...:..........'--.. Material..... No. Compartments 6 Distance to nearest: Well ..._--------------.................Foundation ---------------------- Prop. Line.......-.....:........ O LEACHING LINE [ ] No, of Lines ........................ Length of each line....,....................... Total Length .......................... I 'D' Box ..1........ Type Filter Material ....................Depth Filter Material .._.-- ................................... Distance to nearest: Well -__... ---- .......... Foundation ........................ Property Line -...................... SEEPAGE PIT [ ] Depth Diameter .__..___-- Number .____._._-____.____ Rock Filled yes ❑ No Q D t [ Water Table Depth ---------------------------------•"--........Rock Size ....-...... ..-------------•- Distance td nearest: Well .__.______...-------- ------Foundation ------------- Prop. Line ......... REPAIR/ADDITION(Prev. Sonitation"Permit# ..........................__... ..... Date .......................-----------I Septic Tank (Specify Requirements) ._..__..______ .......t__._...___ <. Disposal Field (Specify Require�ents)—'2rW_'S. ............................... .................-------------- D raw ... -- -Draw existin and re q uired addition on reverse sideI + 1 1 hereby certify that I have prepared this application and that the work will be-done-in accerdanaP-with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Dlstrict.'Homi owner or Ilcen- sed agents signature certifies the following: i ` a;'..�! -- 'r "I certify that in the performance of the work for which this permit is issued, I shall net employ any person In such manner I as to became subject to Workman's Compensation la%(s of California." '' ! Signed ---..... --II JJ - _F-"--• -_ Owner� ,II By .. ...K. ------ - ---------"-------.- Title _Gr!JCs2?2' off... -� - _y_......_... vnf other than owner)i DEPARTMENT USE ONLY //� APPLICATION ACCEPTED BY---- -.. .. . . ........ ....—... .................. ---------------------. DATE .. _:-�f-:� �-----_.......... BUILDING PERMIT ISSUED ...... - - -- ------ --.....................---------...---........._....___-DATE -- --------^----..........---'------- ADDITIONAL COMMENTS .- .:..._......_... — --------------- -- --- ....... - -'- '...... .. ....... .. _ Final.Inspedlon by: ------- . . . ... ..-•--- - ................................ ...................Date -J'=.GA'-='��------------- N AQUIN LOCAL HEALTH DISTRICT E. H. 9 1=68 Rev. 5M