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APPLICATION FOR SANITATION PERM .............................................. �I� (C.o+nplete In Tripticate) Permit No...5.�.: Y} ................................................... This Permit Explras 1 Year Front Date tssuee!! _.. ~ Date Issued d =;x:;22 - uW Application is hereby evade 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: JOB ADDRESS/L ........................... .�CENSUS TRACT CT :1.. ........„....... .............................Owner's Name ......... ?hone Address--- _.. ....__....._.........City..,.G ............................................... Contractor's Name ........ ............................ _........... License ... Phone ,fJXS..P._.. Installation wit! serve: I Residence U-Aipartment House] Commercial ❑Trailer Court 0 Motet❑ Other ---•---------............................... Number of living units:... ..._ Number of bedroorns red-_ _ -'�`1 _Garbage Grinder,. .......... Lot Size Water Supply., Public System and name j .....................»......_ ...... ........ ................._.................. Chander of salt to a depthof 3 feet Sand 0 Silt [� tayr [] ..Peat �].. Seyndy Loam t]- Clay !gyPrivate Hardpan 0 Adobe Q FI It Material ............ If yes. type ............... .._........ !Plot pian, showing size of lot, location of system tri rotation to wells, buildings, etc. must be placed on reverse side.! NEW INSTALLATION: (N a! septic tonic or seepage pit permitted if public sewer is available within 240 feet,} ' PACKAGE TREATMENT { }, SEPTIC TANK 1 Size ...................... ........... .............. . = Liquid Depth ....... ............. Capacity .................... Type .................... Materlal....... _ ... No. Compartments Distance to nearests Well' .Foundation _.. . Prop. Line . Nall / g , LEACHING LINE { j No; of lines l.....------- -el- th..of eadt tine..... _............ Total Length.._......» ar 'fl';I8ox _.f.�..�Type Filter Material ._... . Depth Filter Material 2,P .......................... Distance to nearest, Well .........................Foundation .t....-: ... ............. Property Line ............:........� i� S EPAGE PIT C } Depth ............... - Diameter .... . .............. Rock Filled Yes ❑ No Water Table Depth ........................... .........Rock Size ...................... . Distance to nearest: Well ............. _ __.._»Faunda-Foundation.......... Prop. tine .:� REPAIR/ADDITION (Prev. Sanitation Permit # ........................ '.._._^!.._ .... Dote ...{ Septic Tank (Spedfy Requlrementsl .._...••---......... ...............-JJJ� ....... ........---- ..........- .,.... ».... i Disposal Field ($pacify tiequirements} ...r,s�,,s%c,r_� Y. ................... ................:....... l............................ .�.: ........»....._....---_... ` ......_............................................. ........... I..---........ ` .... . i!.. -thaw existing enc! required addition on reverse side! .. » ..._.... ..........................I f - i I Hereby certify that I have.prepared this appllZ felon and that the work will be don& In mane with San Joaquin ` County Ordinances, State Laws, and Mules and Regulailons of the San Joaquin Local Health Distrid. !lame owner or Baer• sed agents signature certifies the following: "I certify that in the perfarnance of the work for wliteh this permit Is Issued, I shall not employ any person In' such manner as to become subject to Workman's Compensation laws of California” Signed _ .[....--._....- Owner ..................a ........................ TBy ............ (If other than owner} FOR DEPAlliTMENT, USE ONLY c .� APPLICATION ACCEPTED 8Y ..... . -� BUILDING PERMIT ISSUED " BATE : �... ITiO E CO ENT5 _. .....}+ t .....D TE :. ��......... it .... . ��P'�''az�s • J.' Fin0l Inspection by:.........GAL........................• ........._._.. ESI 13 2!i �.. ?.................. SAN JDAQUIN ! f)HEALTH DISTRICT 8/74 3H