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FOR OFFICE USE: .APPLICATION FOR SANITATION PERMIT - . "lyd ICompkt®In Triplicate) Permit No ....7..., ..... ................................................. .. This Permit Expires 1 Year Fres" Data issued Doti 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/LOCATION /K - !1IV4_ r�.. ...It�*l.•41-0afe. . ......CENSUS TRACT Owner's Name ............. -�.. .... .....Pho a �fL :.�f)` .�G' ...... Address 17d' .. 04. ...................City LAq_ ... r Contractor's Name ........... .. .. .-S.ort .........................,License #7.-�:`t.:I ....... Phone W,:W.......... Installation will serve: Residence Apartment House C) Commercial j]Trailw Court [] Motel Q Other G - Number of living units:....../... Number of bedrooms ..3.....Garbage Grinder ............ Lot Size ...li;e� ;e................. Water Supply: Public System and name ............................................................................................................Private Character of soil to a depth of 3 feet: Sand j] Silt 0 Clay 0 Peat❑ Sandy Loom 0 Clay loam 0 w Hardpan;k Adobe CX 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 seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ) ] SEPTIC TANK n � /XL.?,�......................... Liquid Depth ... .. ............ Capacity '369. Type ..[..?�. Material...(� No. Compartments .......' ....... Distance to nearest: Well ......../�?.... ............Foundation .... a.............. Prop. Line ....................... LEACHING LINE qCj No. of Lines . ...al................. Length of each line......Yo Total Length ................. 'D' Box .... .. ..... ..... �- Type kilter Material l��......Depth .Filter Material ..........1.�............................ Distance to nearest: Well ...1-TQ............. Foundation .....40./�....... Property Lino -'`�.�-................. M vS ---....�.. Rack Filled Yes No 0 Vit. SEEPAGE PIT Y� Depth ........ Diameter Diameter ..��........ Number ..._....��..... .. Water Fable Depth ................................................Rock Size vv,1Kiy)................ Distance to nearest: Well ............:; .b......................Foundation ...../A_117:... Prop. Line ...77........... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) ............................................................................................................................................. t Disposal Field (Specify Requirements) ....................•----............-•----.................................-------•---..........--•--............................... ........................................................--..................................................................................................................................... .......... . . . .... -- ---- ------- ------- .........._ •• . ..........•. •..... -- ... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done In anordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilan-4 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 penon in such manner as to became subject to Workman's Compensation laws of California." Signed ........... ......... ........... ............ Owner By --............. --- --------- - `---- .�? Title --- ------ ( r tha caner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - ------ •----•------' --- DATE .....................: BUILDING PERMIT ISSUED .................. ..... .............DATE ... ADDITIONALCOMMENTS --- - ................................. •.._....,......_...-....._........-_............,.... ..... ------- --. -- ..------------- ---- -- -- - ----------- - ----_- ............ FinalInspection by: ------- --------------_---.--. ---- - ---------------------------------------------- .........................Date /1��. ...� ......... ..............- iH 13 2h 1-613 Rev. 5'M SA JOAQUIN LOCAL HEALTH DISTRICT 8�7a 3M