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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �lG ....._ �7_ rya ............ .............. 1 (Complete in Triplicate) Permit No. ..................... ............... This Permit Expires i Year From Date Issued Dane 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 V4160 IKZdex! // 4e-ne- JOB ADDRESS/LOCATION ......�L1h121 cif.y.... �i.F.......... TRACT ..._.............. Owner's Name liC. ' L.__...G'�3�.c�<S4S�............................................................... .Phone Address G► / .� . ./ice .... ......................................City .........�$.Ta c*_�cT� Contractor's Name ...... < r ........ --------IW:C-,.......License # .. Phone Installation will serve: Residence Apartment House Commercial❑Tralier Court 0 Motel❑Other............................................. Number of living units:--- Number of bedrooms ...Garbage Grinder ..'f� ._ Lot Size ........s ...1. ......... Water Supply: Public System and name ...........................................•-............_.------.....................I.......................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat 0 Sandy Loam ff Clay Loam`* Hardpan Q Adobe 3 Fill Motorlal ............ 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,) Iy PACKAGE TREATMENT j ] SEPTIC TAMC Size..-`---?4...J-.x.--� ............... Liquid Depth ........Z-1........ Capacity ...... Type i?r2 -�'! TMaterial.. oa� No. Compartments ......::............. Distance to nearest: Well .__.../'©-P`.'...................Foundation . ... - ..'........ Prop. Line .....LW...1....... LEACHING LINE No. of Lines ....-:T-------------- Length of each line.._....- ....... Total Length .....?.��:��.._... 'D' Box .Y!. . Type Filter Material .�-ir.............Depth Filter Material ....... .................... p Distance to nearest: Well _._/ .......... Foundation ._.. ............ Property Line ......70-..-....... . A SEEPAGE PIT Depth .... '�'__.. Diameter ....33 '.._ Number ........... ........... Rock Filled Yes 7 No 0 Water Table Depth ...............RL> ........................Rock Size ......... ......... Distance to nearest: Well _....... I....................Foundation ....IM....... Prop. Line ....... ��... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ........_.... .................... SepticTank (Specify Requirements) ................................................•-•-----...........•....•..------...............---........................---............... DisposalField (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 accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Wealth:district. Home owner or licen- sed agents signature certifies the followings "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 � ._.. ----- ........ Owner By .. ------------------------- Title --- ------ - -----.-................... (if other than owner) FOR DEPARTMENT USE ONLY ' DATE `�'Z 7 APPLICATION ACCEPTED BY G � ----. 2. . . BUILDING PERMIT ISSUED:.. - ...................: -•-.- _ -- ------DATE ADDITIONAL COMMENTS --------- ----------------------------•---•. -------------- .........-........-............................................. --------....----- .......... ----•---•--- .-..................•_.-..............•............. ........... ........... ....... Final Inspection by: .--_. Date ... e .. . .... . .......... Eli 13 2b 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7)1 3M B