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, i FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT ....................................................•...: Permit No. .....Gl.�SSQ. {complete in Triplicate) _ . This Permit Expires 1 Year From Data Issued 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 Ordinan No. 549 and existing Rules an4 Regulations.- JOB egulations:JOB ADDRESS/LOCATION � 1 .- ; . CENSUS ..._ Owner's Name 7 -- ..:................Phone ..---------------------------------- ` Address _...-... f �... 7 �. ....._....City i ..... .........i............. �....•. ... Contractor's Name ....• Li --- ...................:_•-----.License#+!!0 l....... Phone Installation will serve: Residence Q Apartment House{] Commercial❑Trailer Court ❑ Motel ❑Other... ............ ... ....................... Number of living units:_..__J�_.___ Number of bedrooms _.__d�r'...Garbage Grinder ............ tat Size�� .............................. Water Supply: Public System and name ' ..._._._.Private , Character of soil to a depth of 3 feet: Sand.r] .y Silt❑ Clay [J Peat❑ Sandy Loam or Clay Loam ❑ Hardpan❑. Adobe C] Fill Material ............ 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 ori seepage- it permitted if public sewer is available within 200 feet,[ p� PACKAGE TREATMENT '._ \I [ ] SEPTIC TAMC ] —__ Size..*. A. ----�--`_�............ Liquid Depth ..._ .......... ... 92 Capacity - -p- --__ Type -.. ---__---- Material__ --•--..: No. Compartments --- ------....._ �.., Distance to nearest,Well ..Foundation ........ Prop. Line LEACHING LINE [ ] No.'of Lines ------ Lenth of each sine.___ ....... Total Length ................. 'D' BoxType Filter Material Depth Filter Material /. .................................... Distance to nearest: Wellr_:�_._..:..-............ Foundation ........................ Property Line ........................ SEEPAGE PIT [ j Depth Diameter Number yT •-•------------•- -•-------------- _.......#............._..... Rock Filled Yes ❑ No Water Table Deptl ............... ..........-.....................Rock Size :------------•---.........------ .Distance to nearest: Well .----••----=-.-----•- ..............Foundation .---......-- ....... Prop. Line ...................... R REPAIRJADDITION(Prev. Sanitation Permit# Date ___ _________________ _....... ---_---------------- --• . ._._,.. ) Septic Tank (Specify Requirements) ........:...... -_ - :.:.. ----- --•-- ---------------•-•-•-------...--•---.....-----......•••-----•. -•.._..._.._...._ Disposal Field (Specify. Requirements] -=----- -----------------................. -�:------•--•......................•-••......................................... _ __.------'=---------•------ ------------------------- _______ _____________________ _______-----------__`------------------ ............................................ .......................... .....•........ (Draw existing aad required addition on reverse side) I 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 permitFis Issued, I shall not employ any person in such manner as to become subject to Workman' I sation laws of California.,, `4 Signed ------- -•- ---- +. 9 --------------- .. . ---- - - - Owners r By ---- ------ ---- --- --- ---- - - �irle .� ---- .. . -•------ ---------------------------------------•---•-------------- { of er t er _ FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY -- :. ------ ------- DATE ._ .........--- BUILDING PERMIT ISSUED . - ------ .DATE ._ _. ............... ADDITIONAL COMMENTS .. .._ ...... `= ------------------ -- .................... ............................... _ -------•------ -•---------------- -------»..._ - ti -� .` ..;...4 iz: Final Inspection by: ------- -------- -------------------•- ..._... ----------- .;-...__._..-..._._Date --- `..1` ` ..•-`---.4- EI1 13 2L 1--68 I?ev. SM SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/711