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FOR OFFICE LASE_ T APPLICATION FOR SANITATION PERMIT ' (Complete in Triplicate} Permit No: _ .��--. -------- ------------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the:San Joaquin Local Health District for a pP Y q permit to construct and install the work herein described. This application is made in .compliance with County Ordinance o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -- CENSUS TRACT Owner's Name Name Pey1 ------------------------------------------ - ------------------- -- - - � �l�-/7 --�IG___•�1_.__ -••-- -- ---------------------------- --- -----Phone ------------------------------------ ss --- --- -------------- - - / , ff � IL Address .3 7_-_C /T ��- ' 1l.�! �_� Cityf� • - __+ H --------------------------------------- Contractor's ____________________________ ______Contractor's Name ---- L_ __-__------- , -_-License MR� P14__ Phone Installation will serve: Residence 9<Partment House,❑ Commercial :❑Trailer Court i Motel ❑Other -------------------------------------------- Numberli j-ofing units:___/'_.___ Number of bedrooms _-*�- .--_-Garba e Grinder ! Lot Size _/_- _ - ),,,, Water Supply:s Public System and name / i.a/" r f �---------------------------------------------------------Private ❑ Character of soil'to a depth of 3 feet: Sand❑ Silt.0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe Fill Material 91-6) If yes,type ________________________- � i (Plot.plan, showing size of, lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septicjtank or seepage pit permitted if public sed` is available within 200 feet,) PACKAGE TREATMENT [ ] ' SEPTIC TANK'N SizfA, ______________-_-- Liquid Depth �� i Capacity 19049 Type /`� P ----�'----- i IOWA- ___ aterial_��/7�__�____ No. Compartments Distance to nenrest;_Well -------------------Foundation __Z�__--_--____ Prop. Line __9 -1.-_-_-_--_ s LEACHING LINE No�-6f-tine's'' ` i- ` y .. Length of each line____ _____....___ Total Length _.la ------------- 3 D' Box �. -- Type Filter Material — _ epth Filter Material A?4_ ---------------------- Distance to nearest:Well -------� --._---.--_ Foundation ---fQ------------ Property Line -.4 _----_--_..:_ SEEPAGE PIT Depth _a2d _: Diameter + ----- Number ---- i. ._„ . _ Rock Filled Yes�f No 11 Water Table Depth _-AP��-------------------------------Rock Size/i- -=--- -�` Distance to nearest: Well -----------------Foundation --------- Prop. Lin'e' -`S.._______________ I ------- -_---- - . REPAIR/ADDITION(Prev. Sanitation Permit# -•------------------------------------------ Date ------------------ --------------_) � + SepticTo {Specify Requirernen�s) ---------------------------------------------------------------------------------- ------------------------------------------------- --------- Disposal Field (Specify Requirements) -------------------------------------------------------------------- ------------------ ----------------------------- -------------- ' --------- --- a --------- ----------- --------------------------------------------------------------------------------------}-------------------- . \ (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 le Rus and Regulatians 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 notzemploy any person in such manner as to;become subject to Workman's Compensation laws of California." s F ----- ------------------- Signed ---- g ---�=`-- � - -------------------- - - ------------------ Owner By ----'--------------------- He } _ Y i t (If other than owner) i FOR .DEPARTMENT IJSE' ONLY APPLICATION ACCEPTED 8Y _-_ ._ R "` Y i ------------- .------------------ ----------------- - DATE ----- ------ BUILDING PERMIT ISSUED __.._ � __ DATE ---._-----_ ; ADDITIONAL COMMENTS .F __----�!� -- --------------------------- _ __ _ -----------I _ _ . ---------------------------- --------------- -_ __.._____._______________________________.__ _____.____.____________._______. ---------- ----- ______ _______________________________ _ -__ - ' Date _�/ p Final Inspection by: �� ------------------------- -------------- - f.�-�`T__--�7_ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 { 1 E. H. 9 1-'68 Rev. 5M