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rum UrTfu Uses APPLICATION FOR SANITATION PERMIT Permit No. yG�7 fir (Complete In Tripllcato) . . . . This Permit Expires 1 Year From Date Issued Date Issued s3-. .� ` 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 MWLPIsting Rules and Regulations: JOB ADDRESS/LOCATIO � ..!!il .t'( .. . . ... ^/..�.!� Owner's Name ....... 1�4 /�. s. .l . "/ ..........{,. ..`. ...................... ..Phone( .. _. ..#�?. . Address ....... ...................V!IM................................................City .......................... Contractor's Name ......................G.. ._....._.....................................License# ........................ Phone .............................. installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court, Motel❑Other............................................ Number of living units........)... Number of bedrooms Garbage Grinder ,,��// .. .. ..-!leo.. Lot Slee ---------------- WaterSupply: Public System and name .................................._...................-_......._..........................................Privati,�( ` Character of soil to a depth of 3 feet: Sand b Silt❑ Clay X Peat❑ Sandy Loam(3 Clay Loam Q Hardpan❑ Adobe❑ fill Mate►ial ............If yos,type........................... )Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATIONS (No septic tank or see go pit permitted Ifpublic sewer is ilobt within 200 feet,) :jj PACKAGE TREATMENT ( ] SEPTIC TANK S1xe._...... f:�...........}v' �!�:� Liquid Depth .......................... Capacity�r i .. A Typea°=-CAf/Materlal.6eW A..... No. Compartments ...... .....� Distance to nearest: Well �. ......Foundation....-..0�� Prop. Line .aEACHING LINE No. of Lines .. ._....... .... ..... `/�, •- .....�. Length of each line .�� ... Total length .! � ..5� 'D' Box ...... ..... Type Filter Materla .fA5Kbepth Filter terial ......,,f��.f. ?.. ....� y Distance to nearest: Well .s .... Foundation ...ZQ r1L'Property tine ..... j SEEPAGE PIT ) } Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Cb Water Table Depth ..--••--•-•.. .................................Rock Size ................................ 40 Distance to nearest: Well ........................................Foundation .................... Prop. Line .................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) ......................................... .........--------..........................................._............._.. .......3 Disoosa Field (Specify Requirements) �. ...................•-------.......---------------.....----.....................----•--•-......._.....................--•---....................... ............................. .............•........................................•................................................._...................................................................................---•-.. f (Draw existing and required addition on reverse sada) I hereby certify that t have prepared this application and that the work will bo done in accordance with Sats Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner ar Ilcen-� sed agents signature certifies the following: . 1 "I certify that In the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become su ie t to Workman'1 Compensation laws of California." Signed .. ... ,rrt. ..... ......................... Owner .................... 7itle ........................................................................ ,,/ (If other than owner( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... DATE ... BUILDING PERMIT ISSUED ....... ....... ....................DATE, ....... ...... ADDITIONAL COMMENTS\.,�-� ..7..G....� ra-..�'..>�. ._ `-- ..c !t."V..c .:.,E ........... .......... ection .. .............. .. ... .............. •-•-----...--- ....--•--•....---- ---........ ..---............. ..... .- `2::.........- Final Ins . . .. ..-. pY . .......... ...............--•-----•-••--•................... .......... .....Date ... .. . ................. EH 13 2L 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7It 3M