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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT C y' .•;,,t.•/ (Complete in Triplicate) T'crmit No. Cb y1 y/ This Permit Expires 1 Year From Date Issued Date Issued /ct 'Ie Application ,, hereby made to the San Joaquin Local Health District for a r♦escribed This application is a e in compliance with County Ordinunce No. 549 c,nd existing les and Regulations: permit to ccnstruct and install the work herein T, 7 �, JOB ADDRESS�LOCATI N -'� �'+ Owner's Name •. LIt J A'*/ NSUS TRACT Address Phone �j� Contractor's Name " ' city Ir!�''� erre G�C / c Installation will serve: ..... ••. .license#E -1 j, L Phone . ............... Residence _ .. ...... Apartment House[, Commercial ❑Trailer Court C) Motel ❑Other Number of living units: Number of bedrooms Z.....Garbage Grinder Water Supply: Public System and name /rif lot Size . - . !J ilt .... ........... Character of 3:,11 to a depth of 3 feet: Sand ........... ....... ....Private .. ...................... 19 ❑ Silt C3 Clay [3 Peat.C3 Sandy Loom ❑ Clay loom Hardpan ❑ ❑ Adobe (] Fill Material If yes, type (Plot Plan, showing s ze of lot, location of system fn relation to wells _buildings eta n rst be NEW INSTALLATION: (No septic tank or seepage iced on reverse side.) pit permitted if public sewer is available within X00 feet,) PACKAGE TREATMENT j t SEPTIC TANK ISize .. .. .......... . liquid Depth .. X Capacity ................ Type Material. No. Compartments Distance to nearest: Well '.'••-•••••••••- LEACHING LINENa. of Lines .... Foundation _. . ... Prop. line .._............... � ) length of each line ... . . Total Length . _.......... 'D gox Type Filter Material .. .......Depth Filter Material 7 .,e to nc,irest: Well _........ ......................... SEEPAGE PIT -- Foundation Depth Property line O Diameter � es ❑ No..................... Numbe• Rock Filled Y WatAr Table Depth ❑ ' .. .........Rock Size . ...... ...... . Distance to nearest: Well REPAIR'ADDITION(Prov. Son;totion Permit Foundat(on Prop. Line ................. Septic Tnnk (Specify Requ rements) Date I _/. Dis psol FieldS eci( Re quirements) I p Y (Draw existing and required addition I hereby certify that I have on reverse side)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 sed agents signature certifies the following: District.Joaquin local Health District. Homo owner or licen- "I certify that in the performance of the work for which this permit is issued, as to become subject to Workman's mpensation Icws of California.,, I shall not employ any person In such manner / Owner I etG her than owner) . Title FOR DEPARTMENT USE ONLY 4nPLICATION ACCEPTED BY 301I[)!NG f FR"AIT ISSUED l DATE 4DDITIONA COMMENTS DATE , 7� "A .. 'mol I,.cr•n-tip... t.,, �V � 1 n..•, .