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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) ��-?�� --•-�3� Permit No. - ................................... This Permit Expires 1 Year From Date Issued Date Issued ....................7 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/din compliance with County Ordinance No. 549 and existing Rules and Regulatio -ns r:� JO 0, ADDRESS/LOCATION ,... V,.. sS.......4 /�?..�.N......... .�..................,....CENSU5 TRACT ... .-L!O .. Owner's Name .. ....4. ,5HFI.t�,S..... .Nor�_.>/�R� ..........I............ J.Phone ..................... .... Address ............. .. �. ......S...... .J .1.N...................... City A .................... .... Contractor's Name ....~!.!ff.IG/2..--......................................................license # ........................ Phone;.............................. Installation will serve: Residence Q Apartment House 0 Commercialxrailer Court ❑ Motel ❑Other ---•........................................ Number of living units:.'... Number of bedroom3"'r"!-....Garbaga Grinder` lot Size .... Water Supply: Public System and name ...........: ........... ................ .........................................._...... ..: ....Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ 1 Clay Q�"Pegt❑ ,Sandy Loam Clay Loam ❑ Hardpan Q 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 seeps it permitted if public sewer isavailablewithin 200 feet,) lc PACKAGE TREATMENT [ ) SEPTIC TANK Size...... "'._ X. X.,..� Liquid Depth ... Capacity ....�101a.... TypePA Material...4PAkA7—. No. Compartments ..........." .... once to nearest: ,Well .... .�QQ.�"t":.........Foundation .�,�._. Prop. line .s.. . . .............. LEACHING LINE [ No. of lines ....9................ L -gth•Ad -0-0-ch-flne....... ...rofaa Length ..:.7�.. ............ �/Box � �'D' Type Filter M aria) .9GK-Depth Filter Material . .f ................... Distance to nearest: Well ..�... � � Ar "�� Pr' rty Line .J�............... Distance SEEPAGE PIT [ ) Depth .................... Dia ter ............... Number ............................ odc led Yes (3 No ❑ Water Table Depth ......... #. .. ........................ ..Rack Size ...........�:....... ....... Distance to nearest: Welk. ...........................Foundation .....�......... .J. Prop. Lint ...... . . . .. . .... .... . ro � REPAIR/ADDITION(Prev. Sanitation Permit# ......_ t..) ......'.t � ........................ Date ............... .�. ......... Septic Tank (Specify Requirements) ... l .......... ......._............._. ..........----- . .. . ........................................ .. . .. . . Dis oral Field (Specify R quirements) .... �. .... ... . .. .........Ji ..?� ... ..�✓�R�r��-Cl ........ .... _. .._ _, . _ (Draw existing and required addi on on reverse side) I hereby 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 H th District.Home owner or licen- sed agents signature certifies the following: "1 certify t t in the performance f the work for which this permit is issued, I shall not amp y any jperson in such manner as to bac a subject t orkmapfs Compensation laws of California." Signed .......... Owner k. itie By ...................................................................... l4-v.--.. 7 .............................................. :................. (If other than owner) FOR DEPARTMENT USE ONLY i, APPLICATION ACCEPTED BY .......�R►.-4 .......................................................................... DATE ..... . ...... :. 7 ........ BUILDING PERMIT ISSUED ..........................................................................................................DATE ..... .................... ............... ADDITIONAL COMMENTS .. .............._...................................................... ......}............................. ................................... .................... ... ............................................................... ......................................... . .. ... Y . . .,.� ..ti Finial Insp�tiea .. .. _ _. . Dote _ -g . .. ..... " ,l ............ SAN JOAQUIN- LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev,,5M 7/172 3,