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FOR OFFICE USE: 11 APPLICATION FOR SANITATION PERMIT G � _X................. ................ Permit No. .7q.�. .... (Complete in Triplicate) E. 7� Date Issued ..7. - l. ._. This Permit Expires 1 Year From Date Issued .......... Q iM 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: i -7 2 3 wr JOB ADDRE55/LOCATION ,c rz Thu . ..................."" "._..............CENSUS TRACT .......................... Owner's Name .. i •---•---1�•i•�!!,L_._....�C?_>�Ca_....__�.�r4�,��............. . .......... � _.Phone - --`�.�1..�:�._!`�.:��. Address ""."... '............ ?hC �.C. .".- R1 +>/ ... . .....I � ``City .....S�IQCt<'iC?+� ............. ....... n [ ... Contractor's Name .......0.t._._14.----------W21.S. ""-"................................ License # phone ._.y�.6` Installation will serve: Residence a-11irportment House❑ Commercial ❑Trailer Court ❑ i Motel ❑Other .......................... Number of living units ..... ... Number of bedrooms M -.Garbage Grinder Lot Size . -...AigV...................... Water Supply: (Public System and name ............... „..-" Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ IF Hardpan ❑ Adobe (Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location ofr system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT E ] SEPTIC TANK [ ] Size................................................ Liquid Depth .................... _.----- Capacity -•---- Type -------------------- Material...................... No. Compartments .••--..... ........... Distance to nearest: Well ......................... .Foundation . Prop. Line LEACHING LINT [ ] No. of Lines ---------_- .......... Length of each line............................ Total Length ............................ 'D' Box ......... Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation Property Line ......__..__..._......_. SEEPAGE PIT [ j Depth .................... Diameter ................ Number -------_------..___.-_-- Rock Filled Yes C] No C] Water Table Depth ...........Rock Size Distance to nearest: Well ..................................... Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit 94r ....................... Date ---.--_--------- __.____..----1 r 1 Septic Tank (Specify Requirements) .."...""."....... ..------ - ......................._."...i" . ....................................•......... ......... osal Field (Specify Requi -70.1---L—CA reents} Ltipic OPE, ............ i �............... �� .. . --- .....................................•.......... ......•. ._............ {Draw existing and required addition on reverse side( I hereby certify' that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordina`i�ces, State Laws, and Rules and Regulations of the San Joaquin local Health District. Horne 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 nme subject to W kman's Co pensation laws of California." Signed "." - .-.. . ... .. �. —._..._.. - Owner rT .. ."_.. ... ....................................................... f other than owner) II FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY DATE ..---, - -T ..-�. ....---•.•-- .. ......................: BUILDING PERMIT I UED .............•..... ....... / • ... ' . DATE ........................................... COMM S . ..? ..O D4TI � c � c .......................................... - ....� .......... G.r .........�.C7. �7 /.. ..f........... •--•------ -------•---. � ------- . ".Final Inspection by ..... Date ...... I SAN JOAQUIN 10CAL HEALTH DISTRICT e �, 1.1 24, rll., �--- �.. _ 7 177 q W ,