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FOR OFFICE USE: I[ APPLICATION FOR SANITATION PERMIT ........................................... (Complete In Triplicate) Permit No. . ........................I...................... II. .. _ �. _��._ �_._ �. _ . .. -- c .7—.iS:7G ------- This Perri!Expires 1 Year From Date Issued Date Issued •'•� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein scribed. This application is made in compliance with County Ordinance No. S49 and existing Rules and Regulations: JOB ADDRESS/LOCATION .............. . ..... .................. - CENSUS TRACT .... Owner's Name h ...% .... ............................................r..................................... .-.....-�.-�.�-��11 .�1 .-. . ' Pone Address ...Lid /�� K L ............... Contractor's Name ....... cense # ........................ Phone Installation will serve: Residence ❑Apartment House❑ Comrne ial QTrailer Court Q Motel Q Other....... ..... Number of living units:..A��..-,. Number of bedrooms 3 Garbage Grinder ` lot Size Water Supply: Public"System and name ........ Private + Character of soli to a depth of 3 feet: Sand❑ Silt Q Clay Q Peat Q Sandy Loam ❑ Gay Loam ❑ Hardpan � Adobe o Fill Mcterial - � _ ............ if yes.type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: No septic tank or seepage it permitted if public sewer is available within 200 feet;) �:. ( p � Pa8 P i� PACKAGE TREATMENT { ] SEPTIC TANK fe Size. ...................................... Liquid Depth ....�L................ Capacity lf:�-e?.-__._ Type . Material... - ... No. Compartments ..Z'... .� Distance to nearest.. Wel! 4 ' ...Foundation .. J� ... Prop. Line S I� ........ _. ..... . ./�... .. LEACHING LINE { No. of Lines .--._�....:......... Length of each line......��a . Total Length ��a ,II V Box .• Type Filter Material ........ ..._.Depth Filter Material ....... ..�.... ........ . ..• -.-`- Distance to nearest: Well ......... ty/� Foundation ....AV'. _..-.. Property Line 16-1-111- c SEEPAGEte, PIT [ Depth ....r . ` Diameter .3 . ... ........_,r__ Number .--- :ate.......... Rock Filled Yes � No C] Water Table Depth ................. `.!:'..._.................Rock" Size .f�................. Distance to nearest: Well ........,�C�a. ....Faundatiorti ......1° _. Prop. Line S. i REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. . . . Septic Tank (Specify. Req irements) i Disposal Field .(Specify Requirements( ................................................................................ ........ ...... r ........................ ................ --------............._ .... ... ....... ... ............. .................... ...... ................._ .......-----....--------......--••--...... .... . (Draw existing and required addition on reverse side) Uhereby certify that 1 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 perfo+cince of the 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." ' r Signed .......................... . Ow ne r EY t ...... .. ........: :tie � � ............... ...........(If other than ....... owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......tom........e...- ....... . .....-........... :... _ DATE'... �L. ..7....._.. .:. BUILDING PERMIT ISSUED'11' • """-" ........................ .. .....................................................•--... ..............DATE .---...---'...............---•-•-- ADDITIONAL COMMENTS '.i ....................................................... .......... .............................................................................................................I......... '...... ......... . . .1 -•--------•...........----.........................................................-•------•................I._........._..... .............................. ..... -•.......................................•------------......................_....-.......-.. Final Inspection by: :. .........pate .tj� ......................... r' SAN JOAQUIN LOCAL HEALTH DISTRICT