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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT '... .. . _........... '� Permit No. .... Z.J3S (Complete in Triplicate) Qe' •••.. ........... p p !141 This Permit Expires 1 Year From Date Issued Date Issued ..5�.��a: .. 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/...............((J__ ._...._. .............__... .-........ ../...:.................CENSUS TRACT ................... Owner's Name ........ 1 [-l c.1.- pie .0 0./................. 1.Phone .................................... Address ... ............................... ... City Ci �T�^ Contractor's Name ...............0-11velk7P_r----------------...............................License # ..._.._._.. ............ Phone .............................. Installation will serve: Residence-WAportment House 0 Commercial ❑Trailer Court ❑ Motel 0 Other . /SS � 3 3 t Number of living units:... Number of bedrooms ...3...Garbage Grinder ..f-✓Q.. Lot Size ... Water Supply: Public System and name ----............• -•-•---•--••--....---...-•••-•-- •.-----....-•--•--•--•..................................Private W Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobee 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 f ] Size................................................ Liquid Depth ........................... `eKl_S Capacity Type .................... Material---------------------- No. Compartments ...................... . Distance .to nearest: Well ....................................Foundation ...................... Prop. Line ...,....._.G..,._.,....... Z LEACHING LINE No. of Lines Length of each line--- t.._... Total Length ... QU 7 C �,! Js 'D' Box ............ Type Filter Material ..Y-Rck......Depth Filter Material ..../J.."'r �.................... . Distance to nearest: Well ....65,...... ......Foundation ....` .�_......._.. Property Line ....J`�.�......::.-. f SEEPAGE PIT _. . ..r [ ) Depth .._ ........... Diameter �..1�f�..... Number ---------r................. Rock Filled Yea No Q Water Table Depth ........-l.Q.................... ....,...Rock Size ................................ Distance to nearest: Well ..... .........................Foundation .../0.r......... Prop. Line .... _......... REPAIR DDITION rev. Sanitation Permit# ......_..................................... Date .................................. Septic an Specify Requirements) ..... Disposal Field (Specify Requirements) ....� '��L--.-....L-�d.-h L-- - <<'? ......c X. K . --- (Draw existing and required addition 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 Health District. 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 beco subject to Wo 7an's Com ensation laws of California." Signed .. fit --�% Y..1 Owner BY ..................................................... Title ................._..........................._. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ....� .. �...? :............. ...............................BUILDING PERMIT ISSUED ... ....... • ........ DATE ........................................... •-•.................................................................. ADDITIONAL COMMENTS .............................................. ........................... ............................... .......r-_-..-- .'�-.--..-................................................................... ............. ..,.,..._.....................•�r Final Inspection by `: f .)�... ...... SAN JOAQUIN L L HEALTH DISTRICT E. H.13 241.68 Rev. 5M 7/72 3 M