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res[ 4rrr:gx U= APPLICATION FOR SANITATION PEeMIT ....'.......................................... y (Complete In Triplicate) Permit No. .. ............................ .......... . . This Permit Expires ] Year From Date issued Date Issued .�a .... Application is hereby made to the San Joaquin local Health District for a permit to constnict and install the want herein described. This application is made In compliance with County Ordinance No. 544 and existing Rules and Regulations: .IC)8 ADDRESS/LOCATION ....... b..... 6?` ................................................... . ....CENSUS TRACT .......................... Owner's Na ... me ..IQE.S/....... {�i..�..��.......................... ... ..................... .....Phone .................................... Address .....-....��n...V f./� 414//428.. .044 3& ".._..._ . ............... City ...: 15.l .l�'?.................................I.................. Contractor's Name .....:... ........ ..............................License2o!�?ZX...... Phone Installation will servo Residencej§Apartment House[] Commercial❑Traller Covet Motel❑Other............................................ Number of living unit:.../.... Number of bedrooms . .......Garbage Grinder ............ Lot Size l�' XZK ................ Water Supply: Public System and name ....__..1:1�.__...-.............................._........................_. .......... .... ...... .Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ day Loam ❑ W Hardpan❑ Adobej, Fill Material ............if yes,type............... ............ (Plot plan, showing size of lot, location of system In rotation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 204 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK ] Size!...................................I....._... liquid Depth .......................... Capacity .................... Type .............. Material..I% No. Compartments ................... Distance to nearest: Well ...Foundation ...................... Prop. Line LEACHING LINE [ ] No. of lines ........................ Length ofteach line............................. Total Length ........................... 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well .............. ........ . Foundation ........................ Property Llne ........................ SEEP_ A PIT [ I Depth .................... Diameter -------- ....... Number ............................. Rock Filled Yes ❑ No C3 . Water Table Depth ....................................... ... ...Rock Size ................................ Distance to nearest:Well ...................... ...............Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit,li .............................................. ate ._........ .[ Septic Tank (Specify Requirementsy ......... ,c1/A?J-....... ..... � .. . ..�. ...� -AV! ..... Disposal Field (Specify Requirements) ............................................ 0...f......----•..._._...................._......._......._...................... ................•--....--•-----.............._...................._........_..----._............_..........._....................................................---.............-•---................... (Draw existing and required addition on reverse side) I 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 Health District. Honkie owner or (seen- 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 become subject to Workman's Compensation laws of California." Signed •.-....... ...... . .-•--•........................... Owner.....-.. .,- BY ............... ....• . title -------------- ............................ . ,. (if other than ow DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ..... ............................... .... ......................... DATE j. ... ... .: .. .----. .: BUILDING PERMIT ISSUED .... . ... ...... :... .• ..........................................................................DATE .... ...... .�........... ADDITIONALCOMMENTS . ..., -•-- ..................._...............................................................:.........................I- ---------- ----- -- • .. .------ • .......................................................................-........................................................... ....................................... ............................. ..! ... e.... ..................----...................................... ..........--............-.-..-...........-. . .. ...... Finnlinspection by:/:- ..... . . . . .�,.J...................................................................................Dat � ,� �.- ............... Date ./.. / Ell 13 2a 14W 5k, SAN JOAQUIN LOCAL HEALTH DISTRICT 3H i ,�