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Ik FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................. . ........... v (complete in Triplicate) Permit No. ..-,7 ................. ....... ................... �.: Date Issued ...7�....._._.�_.. - I- .......... ....................... This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. This application is Mc e i rw' Coun-ty OrdinNo. 549 and existing Rules and Regulations: JOB ADDRESS LOC ION' / ._... _. _ ��,� �......CENSUS TRACT .......................... Owner's Name i./I ...._..__...! c e..... . ...-•............. ... .... E Phone ........................... Address .... �. .......... Cit. -_. . -•...... . ......... . . Contractor's Name ._._ fit.. License # 71-�...a�7.... Phan Installation will serve: �� Residence partment House 0 Commercial ❑Trailer Court ❑ i �! Motel ❑Other -------------------------- ---------k-••- 6 Number of living un ...... Number of bedrooms Garbage Grinder_ Lot Size ..l f. Xa ........... Water Supply: Public System and name ' i .....................................__. . riva �~ .-•-----------------------------------=•---.:--,:--:,.....--• _. private Character of soil to a depth ofr3,feet:, Sagnd 0.r Silt.❑ � Cl.ay Peau❑ Sandy Loam C] Clay Loam [] Hardpan ❑ Adobe' Fill Material'..YG'.. If yes, type ................... ---- G (Plot plan, showing size of lot, location ofsysteminrelation to wells, buildings, etc. must be placed o0ireverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` W PACKAGE TREATMENT ] SEPTIC TANK JAro ff Liquid Depth -.-`1.�,��.....,...._. ,'Capacity c� ___._ Type :t Material-__ -C�o. Compartments _......... ----... d.(. Pro Line .. .L7. LEACHING LINE Nuance to nearest: Well _._.�1 .................. .Foundation ......._� _. p. �. of Lines .--- . ...____... Length of each line._..��j_ .. Total Length �...............� it �I Q V. Box Type Filter Material p.r .....Depth Filter Material _... .:......................'7 r _te'r . . itan to nearest; Well .,� Foundation .._ 1 .. ... ......... . r _.,1�...-......_. Property Line .---•=----------•--•---- N SEEPAGE PIT De is 33 „ [ pth -- �--------- Diameter ..............•- Number ..:_�......�...... Rock Filled Yes �f�7o I�] Water Table Depth .Roc k-SIze :..7e.12 vY... / r�......41 ... 'q , l Distance to nearest: Well ..,....,� .......................Foundation _, ............. Prop..Line AZ......... REPAIR/ADDITION(Prey. Sdnitation Permit# .............. .. - --------------------------- Date .................................. SepticTank (Specify Requirements) ......................................... ...............................•....................... ..............---•-•.............. DisposalField (SpecifyIRequirements) ........................................................................... -----•--------•-•v------.... "-------------•--------- II ...........-.......................---------------------------------------------... -----•---•- -------------------------------------------................. ----•-- -------.........I....... jj (Draw existing and required addition on reverse side) 1 hereby certify that I have 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 Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall_not employ any person in such manner I as to become subject to Workman's Compensu'lion laws of California." Signed ................... .........--- --•--•....------- ....... Owner By -----... :_... ... ....... . . ...... Title .. I ......... (if than"owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............ ............... ............ DATE .....LL=.�..----•••---- BUILDING PERMIT ISSUED '.' -------•--•-- ------------------=----------------DATE --•--•------••---....---•--....•---- ADDITIONAL COMMENTS .° A....................:.. _.... ---------------------------------- .................. .............................................. ....................•------------------------------ .................. ............................. Final.ins .ection--- .. --------- 11' ......................•---•..................................................................... ._.,_.._.. .. ...............I....... PY = --------------- ----...........-_----••---_............................Date .... � r� /�3...._...._.... m 41 ._ _USAN JOAQUIN, LOCAL HEALTH DISTRICT E. H.13 24 1-'613 Rev. 5M - 7/723m