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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........................................ (Complete in Triplicate) Permit No. ..................... Dote Issued .3.: � 7S __..... This Permit Expires 1 Year From Date Issued ......•... 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/LOCAT ON �1 _ e z�' •2� J� • J4.K ...... .....a.,..• •-•.....r......._.._•••..•.•................................, ..............CENSUS TR/"� .................................c.... Owner's Name ---,. �...... , -- .�..:.-. ._.._._._.. �.,...�-._.Phone . ' Address ._.._ 2,/P9e ... .. -- .... ...'City ...0 ........... .............. Contractor's Name ............. ........... .J ,.u ��... ........................ ... ...: .. ..............License # . � � -- Phone .............................. Installation will serve: Residence ❑Apartment House C] Commercial'❑Trailer Court ❑ Motel []Other .........14!/¢ &..::........... ` Number of living units,............ Number of bedrooms Garbage Grinder lot Size -Water Supply: Public System and name .................. ....Private 1 Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat 0 Sandy Loom Clay Loam ❑ Hardpan ❑ Adobe 0 Fill Material ..._..____ If yes,type ............................ I (Plot pian, showing size bf-Iot,Tlocotion.,of. system in relation to'.wells, buildings, etc. must be placed on reverse side. { NEW INSTALLATION: (No septic tank or see p ge pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK J Site--,�� -.- • �... `............... Liquid Depth _11/................. Capacity Qf�. ...... Type ..-. _ ... Material•..e- ct'_... No. Compartments .. ............... ,Distance .to me rest: Well ..___.2� ..... -••-^-:Foundation ------ Prop. line . _.................. ( LEACHING LINE [4x-No. of Lines ,(� ' ,..:..�.............. Length of each line.---.�,�P . .... Total ,Len' 'X' Box ........ Type Filter Material :_.....5.!f.:.. a th Filter . D r Material .... ...:. .: Distance to nearest.• Well � .......�l�:. Foundation .._.� .--_. Property Line .....��... Depth / p; r2l� uf mber Rock Filled Yes ( o Q - Water Table Depth. --- ..... ..- -. .............:........Rock Size ... ___1 .Distance to nearest: Well .......:.... :p .....,...Foundation ._.,1� .-•_--- Prop. line Y.-Ilf. REPAIR/ADDITION(Prey. Sanitation'Permit 0 ....:....................................... Date ..............................:...) F�.bx.r,,7 _... _ _ _ — _— Septic Tank (Specify Requirements) ...................-................................................................... :......_....:......:_....-..... �................. 4 Disposal Field {Specify Requirements) ................................................................. ...................................................•_.................................................................... ...._......_. :..... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Scan Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or liven- ' sed agents signature certifies the following: certify that in the performance of the work for which thisermi p tis issued, I shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed .................................. ................. Owner , By ........................................ u .......... . itis (If other than owner) --•..... . .....................................::::.. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , a ..... BUILDING PERMIT ISSUED .............:...........•........ DATE..rr�`.? -_? ..5+----........ ..............•---:....._..................._..........................:.......-----.......:..............DATE..........__....._.................._...._.. ADDITIONAL COMMENTS .......................:........................................ Final inspection b..�.... ... .. . ....-s............................ ..•-•-•----.......................... ------....-----•............................ .................................. ....................................... Y W... . ... ....... ate .." '.�.5~................ ........ w _ ,SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 F. H. . 1--68.Rev. 5M 7/7239