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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT q 11.f Complete in Tripllcatel Permit No. .` _. .... This Permit Expires I Year From Date issued Date 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, JOB ADDRESS/LOCATION XZ ...j.............CENSUS -TRACT ...-....-.. ... ...._.. .. Owner's Name ....,eh .. .. 14 . ' L, .l. Phone --......T". . e Address Contractor's Name a-.--.1� /7z�1-------------------- ------------License # .....------....... 'Phone6w 3 I Installation will serve: Residence(Apartment House C] Commercial C]Trailer Court 0 Motel []Other---------------------•-........... ......... Number of living units:-----/_-_ Number of bedrooms .____Garbage Grinder ------------ Lot Size ____________________________________________ t Water Supply: Public System and name .. !. �Le4_. ....................................Private (] Character of soil to a depth of 3 feet: Sand' SiZ Cloy ,0 Peat❑ Sandy Loam ❑ Clay Loam n Hardpan 0 Adobe 0 Fill Misterial ............ If yes,type............... ....:....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) d NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC Y NK{ Size _ _•---. Liquid Depth ...............:......•---1 j , Capacity ..� ------...... Type A'e,;. Material.4; o. Compartments 1" Distance to nearest: Well ..._ *SW9..............Foundation ---.��. . ___ Prop. Line .--_ _.._----_- Length a# ath fine-_: Total Length .._.__. ..... .. LEACHING LINE No, of � �j D' Box .._..J-... Type Filter M��JJteria! f_...... f€?epth Filter Material _--.-. . Distance to nearest: Well ...1.?� �.-._ Foundation ------/b.-.--.... Property Line ---_-_--J`�.....:.......: SEEPAGE PIT, [ ) Depth --------------- -- Diameter ___.___-____.... Number -....-....-.--..- ......... Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ....---------------------- Distance to nearest: Well .........-...........•..................Foundation ..............- : Prop. line .......................6* I REPAIR/ADDITION(Prev. Sanitation Permit# -•-•----------------_._.-•_----_--_------ pate ..................................) P ! SepticTo {Specify Requirements) ..............................................•....------.....-•--------••. .................................... _..---..................... Disposal Field (Specify Requiremerits) -----------------------•-•---•--.----_------------• _---------------------•----- ----------------------------------- � -•------------------------ •---------------------•-----------------------•- - - :.--... ----------- ...................... (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. Horne owner or liven• 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 sue manner as to became subject to Workman`s Compensation laws of California." Signs -•------ --•-•--- ..----------•---------------------------.. Owner r By . other than owner) ------ Title --... - { it P MENT DISE ONL APPLICATION ACCEPTED BY ......._/0- /-----•• ----- DATE -f = BUILDING PERMIT ISSUED -----------------------------------------------•-----•---- ....... ----DATE _... -- - . ADDITIONAL COMMENTS - -------- -------------------------- --------------- --------------------------------- -------------------- ----------- ------------------------------------............... .................. •-------- ........................... ---- -....................................... ----.--........ -------..--.....-......................... .......................-------------------------------- FinalInspection b -- •-- -------------------------•-..._.-.....----------..--------- ----- 2�---....--:------....-. py: ..... ---- -----------------_--- _- --------- .....Date ......��'/ 1......9-�-.-'-.--.-..-. EH 13 2!t 1-68 Rev. 5M SAN JOAOU ro LOCAL HEALTH DISTRICT 874 3M i