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V4 (.�Q'Tt.C1.�Y_a�.e- �..-.-ti aT ,T.y..�! �:C'NF�.,!Ky�. �t. r ... _ Y:.y..n 1Z #� ? �•' FOR OFFICE USE: / USES APPLICATION FOR SANITATION PERMIT FOR OFFICE E ...........:.............................. ............. 7A_..�/ ` (Complete In Triplicate) Permit No.. ..q_-- t.... •~----.............-............... .•.............. This Permit Expires 1 Year From Dote,Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des crlbed:- s This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations, e+r ' JOB ADDRESI ON.. ... .et.G.�.... .... / _CENSUS TRACT:_.............p Owner's Name..Cx/�✓4•P!�. ._ i_- �r ,r ... Z .. ... .. .Phone Address....QO�.ID 6 .. . ........................_........ .....City..... ....i� ............Zip Contractor's Name.. License y ...... .................. ............... a !r3 ..l..r,3.�. anstallc:ion will serve: Residence' Apartment House❑ Commercial❑ Trailer Court ❑ Mot-4 ❑ Oth:-r.................. . ...... ................ Number of living units:...... .....Number of beds ooms...."2_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❑ Sandy Loam❑ Cloy 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: tic No se tank- ( p '' or smpage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK O Size...........................................................Liquid Depth Capacity.. .... ........ Typr ......................Material............... .................. ..... ...........No. Compartments . Distance.,) nearest: Well. ........................................Foundation.......... . .............Prop. Line...... LEACHING LINE ( ] No. of lines ............................Lenot� nF each line..............................Total length...._::.............. ........... r 'D' Box............Type Filter Material........ ....Depth Filter Material......................... ' Distance to nearest: Well......................... ..Foundation............................Property Line........................ ......:' SEEPAGE PIT [ is 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.......................... .. lyA/I /J Septic Tank (Specify Requirements)...... .:...,..,....l....�.. .. � ....... ........._. ..:...............�� . ... -.Disposal Field (Specify Requirements)... ........�,��Q.... ..........--•.......................................................................•-........................................ :. _ .'..... ,.. .....---•-••-•--------------•------••-••-•--•-••----------.,........._......................... ..........---.............. .. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicatlon and that the work will be done in accordance with San Joaquin County - Ordingnces, State Laws, and Rules and Regulations of the San Joaquin Local Health District, Home owner or licensed agents,, , signature certifies the following: F "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner 9 ( t to r an's Com ensation laws of California.' 3' Si ned :... . . ,................�_.... C1W ner an to becom s j �1 B� :...._ .[.�/. �rft./..�........ itle.......(-•`! 1 `•••-••..................................... .. ter. .. ._ ... ,• (if other than owner) s' R DPARTMEtff USE ONLY ti r APPLICATION; ACCEPTED BY........ ..... . .... ..... . .. ......... ......................:..DATE......../ ..��..7�....::..:..:i. DIVISION OF LAND NUMBER.............. ..............DATE............. '. -ADDITIONAL COMMENTS......................................................................................................... .....:.........................................................................._............................................................................................................. :_.. s•. ......................................................... ...... .... ........__....... ................................................. Final Inspection by:................... .. ... .. ... . ... :.:..:Date/ ::...::....... .: . t u ae � � :u Bien ssv.r e 1� iy SAN JOAQUIN L HEALTH DISTRICT n saM �t "a. r •��-� .�ir"Zt3�FPiih '�'''X�ir+A:'i`rff�Yii:v+i.;.�..W ... .......- ._..... ..., ..,.,.��_..._._ .. ._ ._�..,»_.....�... ..ten,..,,. is