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FOR OFFICE USE: I �� TPU ATION FOR SANITATION PERMIT (Complete In Triplicate? 4 Permit No. _...7.............. Date Issued ..... .... / ' p es 1 Year From Date Issued ............... /nJoaquin is Permit Ex irApplication is hereby madeto t e Locc ltHealth District for a permit to construct and install the work ,herein described. This application is m e�in compliance with County Ordinance No. 544 and existing RuI9 and Regulations: JOB ADDRESS/L_OCATION �J.!. �. , i. _(,�� ?.. � ` _. C` j$SUS TRACT Owner's Name'y .. .C: ... ---- -------- Phone t Address r. !/ � _....... Ci r.... ...................................... ; a tY_ i�� Contractor's Name _. � F. .. ;...§ �C?. ...2 -•-------------------------- ------••.License --- --�:.__ Phone . Installation will serve: Residence portment.House 0 Commercial ❑Trailer Court 0 ( { k. . ,}Motel-❑Other .:........................:.............. Number of living units:....... Number of b oo s .---- 0 ba G nder � ' Lot Size Water Supply: Public System and name .._.. .:. ..........................•---Private Character of soil to q depth of 3 feet. Sand=j . Sil ❑ Clay eat 0 ' Sandy Loam: Clay Loam [] } Hardpan p E] Adobe ;*IV1 Materiai/�T.... If yes,type .............`.............. (Plot pian, showing size of lot, location ofsystem in relation to wells, .huiidings, etc._must_.be, plated on. reverse side.) I ' NEW INSTALLATION: (No septic.tanlc..or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK„ e...... .- Liquid Depth Ca acit , p y Type .VI /7, aterlal l J.----_. No.' Com artments QDistance to nearest Well Foundation .. �....-- ---- ------. Prop. Line _ 1�.... r � # LEACHING LINE [ No.. of Lines __..--.--. Length of each I e. Total Lenth ........ 'D' Sox _ •.�- Type Filter Material ...-Depth Filter Material _ Distance o nearest: Well __. _.--,- Foundation/ �............._.. Property Line 3Z......:....... E PIT [41----Depth _,,2S __....... Diamet r -- Number : :—.:.: J Rock Filled Yes No Q SEEPAGE � --•- Water Table Depth ------------ --- -•--..._.... ._.._:....Rock Size /A,Z y � o r�� _ •••---... _ Distance to nearest: Well .:-- ---- � ....-- Foundation .-. .1...`..Prop. Line. �...... ....... ' F REPAIR/ADDITION(Prev. Sanitation'Permit 5# ........... .........__ .................... Date ---:...:.:.............----•-.... Septic Tank (Specify Requirements) 1...:............•- 'i Disposal Field (Specify Requirements) __••.......................................'...----------•---...___...__ — ----•--- -------------- - j f ________ ___________________________________________ ____________________________________________•-....__.______----. _ _ _ _ (D aw 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 Joa4uin Local Health District. Home owner.orlicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not emploj,any person in such manner as to become subject to Workman's Compensation laws of California." Signed - .......:...................... . �y _....---•---. . O cc� ner �L By ----- ............................... . ..... _.�.. .!l f�1..�-------....... Title �.... . ..:......Z/----------------- (If other a owner) FOR DEPARTMENT USE ONLY APPLICATEON ACCE� ED BY... .:.... .... ...... DATE _S.. ..Z._ .�..' ............ BUILDINC PERMIT ISSUED :..:_..._.:::.............................••-----.. ..... RATE ......................... ADDITIONAL COMMENTS --•-•-......_•---•............ ... .............I............................. ....... .............................._....... ................................................... --- - ••• ----------- k ------._...•----------------------- -----•--...----••- ---•-- 1 Final Inspection by: ....'... :... Date ... .`3. ............... . SAN..JOAQWN,:LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 11 13 „