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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: (Complete in Triplicate) Permit No. - lJ,3 .. . -----. . ------- .- This Permit Expires 1 Year From Date Issued Date Issued./4__V6.-.,2e 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; ( JOB ADDRESS/LOCATION_...._ �� has -------- ---- --CENSUS TRACT.._.....--- Owner's Name....... •.... .. - . ........................ .... Address. - - �.-. . . - one- - GG -• // City... Contractor's Name So �Q/ ............ . ZAP / -p - . . . - ..... License Installation will serve: ' Residence Apartment House❑ Commercial0 Trailer Court ❑ Motel ❑ Other..- .......... Number of living units:.......C....Number of..betdrooms ..."Yba e Grinder_.--__.__•'_ l , 9 Lot Size..-- --�••�!��..... ---.. Water Supply; Public System and name.... ... ..:....... . ' s - ................ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ .Clay❑ Peat I] Sandy Loam 0 -Clay Loam ❑ Pn ate'❑ t Hardpan Adobe* Fill Material...........If yes, type... ............. (Plot plan, showing size of lot, location of systemein relation to`wells;,budcliggs?,etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit 'perm tied if public lic sewQr is available within 200 feet,) W PACKAGE TREATMENT ► I ) SEPTIC TANK [•) Size:.---=--•T.__xs- -- Liquid Depth. ~:---......... • Capacity.-. td ,- 4 ........ Compartments------- _--..- cam► ---:Type. I I 1 Distance to nearest:Weil'. .._..__. ? _.... ,.'_......Foundation...-_.-_a.. .....Pr �Cf- op. Li e. LEACHING LINE No. of Lines._...__. __ - � t .. .._ ... -- ----------'i--Length of eac li' t 'n`e "•.. ;-,--:.-- Total Length.._ --- --••---- �//�� -S D' Box. .......... Type Filter Material. �i�.(rti.__Depth Filter Material..:................. G Distance_to nearest: Wei l-:..: �......"=-._::-Foundation.:/0..._f- Property Line... "Y_ SEEPAGE PIT L - -.:.. i Depth_ .�i�''�Diameter.`"�3�r ;.. .. .r•..� • , � .._.T. .. ` .. —_ - . ....__...Number..._. . . r e - Rock Filled Yes No❑ Water Table Depth._:"'- ...... ---- ...............•.....-•-- -Rock Size { x� Distance to nearest: Wei(:.- �1��--�'•'� _--_fouridation......r 9-'. -.Prop. Line. �'� y i REPAIR/ADDITION (Prev. Sanitation Permit .............. :- -• . . . C Date::-. r.-�.....- Septic Tank (Specify Requirements).....,. ...: .................... .......... isposal Field (Specify Requirements)------.-------.--- , ----- .............. = .a..- �- . .-- ---............- ------- ---- ------- - ... •� = ' .�. •. - ------- - -------- -- t (Draw existing and requires�a[Zldition on reverse side) " I hereby certify that I have prepared this application and thattthe work•will be done in accordance with San Joaquin County~� Ordinances, State Laws, and Rules.and Regulations of the. San Joaquin Local Health District, Home owner or licensed agents signature certifies the following: "I certify that in the )� performance of'tbe work for which'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.. -- -- 1 .... . By,. T Owner ---- . ......._. _- . jam. i - :. itle..........--. ` r r ( of er than;owner) FO DEPA ME T U ONLY APPLICATION ACCEPTED BY... • . ........ , DIVISI OF LAND NUMBER.............._.. •.. . . .-•---------------- .. .....'DATE ----- ._.......- --• ........ ...... ......._...---.DATE.... ------.. i ADDITI AL COMMENTS....... ............. - ... --. ..._.. --- .# ... . r.. ..•-- ------ -------- -• .. :............_.--•--. .. ..---- - ..... ..•--•- .._- ......... ....... ------------- ------------ ----- --------........-inal Inspection-b :Date.-----:� "?�dH 19 24 y�• - SA JOAQUIN LOCAL HEALTH DISTRICT F 21677 REV. 71746 3M