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FOR OFFICE USE: (� APPLICATION FOR SANITATION PERMIT ........ ....... ....... ..... . ...7..�:.3 97 (Compiato In Triplicate) Permit No. ---------------••-- ..................................... This Permit Expires t Year From Dotelssued Date Issued ._!6:..3; 5� Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRfSS/LOCAT Na7,;,a-.L _ . . �. ......CENSUS TRACT .....,... ................ Owner' N l! / Owner's Name . . .. . ..... . .. �................... �D�V..... q.!'f�}��'.�.�7., ...... . ..... .. .......Phone ......... ................-........- Address - . . .... _.......................I............ City ...... ... Contractor's Name ---- ''.._., ./ .........License tlt .IAZ3&�... Phone .............,:.....,..._.... Installation will serve: Residence[i�Apartment House Commercial OTraller Court C] Motel❑Other............................................ Number of living units...../..... Number of bedrooms ..Z.....Garbage Grinder ............ Lot Size .0... ..... �,�................. Water Supply: Public System and name ...............•-•----............._.........................................................................Private [ . Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay [J Peat 0 Sandy Loom 0 Clay Loam 0' Hardpan j] Adobe❑ 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 or Tseee pit permitted if public sewer is available within 200 feet,)PACKAGE TREATMENT j ] SEPTIC TAMC Sias Jr! J� �t� 5 ..`....... Liquid Depth :. . .... Capacity 16!400e -a►--... Moteriai.�e:'.`-e-........ No. Compartments ..,2................Distance to neate -So ` ` Well --•---•...................•..Foundation ..../41............. Prop. Line ...r`. ................V LEACHING LINE [rf No. of Lines -----.f........... .... Length of each line------ ....__... Total Length �.....- � 'D' Box .r-._.... Type Filter Material ......Depth Fitter Material ... 1`9....r..............................� Distance to nearest: Well ......5'O............. Foundation .../,O............... Property Line .-.. ................0 SEEPAGE PIT (*f/ Depth --a-5......... Diameter —!? 4... Number .........Z.............. Rock Filled Yes 0"" No �~ Water Table Depth -------------144 .................Rock Size ...1- ...................... , ._`a'-#.~_.... o s 10 Distance to nearest: Well ......-/A0........-?.............Foundation .../.-Q-........... Prop. Line ......: . *............. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) X SepticTank (Specify Requirements) ...... --•----------•-----•...................................................................................------.................... Disposal Field (Specify Requirements) ..................-..................................................................................................I............... .. --------- ---- -------------- -------------------- -----------------------•-----•--------------------.....--•------........_........_.......-----•--....-•-----•--...------.......................... - ------•---------------------------------•---------.....--•---.---•----------...........----------................--•--••....-•-......... (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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-Distrio. 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, i shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ---- .................. 4-1-1 Owner L 4 Alor�x By Lf - � title .., � .. (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � r. _-------••-------------- ------------------- ..-•-•--•...... . DATE . - BUILDINGPERMIT ISSUED -------- -------------------------------------------------- -------..---------------------•---.......DATE -- ................_:_...... ADDITIONAL COMMENTS -----....... ... . ............. ................_ . -------- ---------------- ................................ -------- ------------------.................. ---- -- _........._.._... ....... --•---- ........--------------------- ---------------------------------- ................... ...........-.------ _....._.-..-... ------------- ................ - - ..-.-... ,/.. Final Inspection by: - --------------- - .............................................................. .......----------Date . . �} . �� EH 13 2h1-613 Rev. 5m 1.- JOAQUiN LOCAL HEALTH DISTRICT 8/7a 3M C.tf3