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r`"` "rr'" "," APPLICATION ICOR SANITATION PERMITVA IComPleti irate) Permit Na. ..� . ............................................ FThis Permit Expires ' Ya. -front Date Issued Date Issued .7.y....... Application is hereby made to the San-.Joaquin Local Health District for a permit to constrict and Install the work herein described. This application is made in compliance wltN County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..L 7. h?.J�1_ .. ! .l..__. T................................CENSUS TRACT ................... ._.. Owner's Name ....M.Q /?4�./ h�....,/........ ..... :........ ............................... Phone , /... . r. . .... tikdr}ress .. .... ,� `f�...�.Y:� L..�fl9 �!`�.�1. ... - ��-- -... City `� ..................... ........ --- --- .. Contractor's Name f� .__ ! ieertse # Phone �''� installation will serve: Residence O.Apartment House Commercial OTrailer Court 0 [ ` Motel 0 Otlter..................... W pp Number of living units:...... ---. Number of Bedrooms .r. ......Garbage Grinder ....__.___-. Eat Size ,!.. r. .Sri................ Water Supply: Public System and name .................................._.._-.�t ��l�_.� . _.....: 1 :................Private 0 Character of soil to a depth of 3 feet: Sand b Slit 0 ' Clay 0 Peat 0 Sandy Loam 0 Clay Loomx,_` ' Hardpan 0 Adobe M Fill Materlal ............ If yes,type !Plot plan, showing size of lot, location of system In relation-to wells, buildings, ate. 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 t J Size................................................ Liquid Depth ......................... Capacity .................... Type .................... Material,...................... No. Compartments ..................... Distance -to nearest: Well ........:...........................'Foundation ...................... Prop. Line .................._... .-EACHING LINE [ J No. of Lines ........................ Length of each line............................ Total Length 'D' Box . ......... Type Filter Material............ .......Depth Filter Material ........................................... Distance to nearest, Well ..:..................... Foundation ........ Property line SEEPAGE PIT [ ) Depth ..................... Diameter .........:...... Number ............................ Rock Filled Yes ❑ No (] Water Table Depth ....... ....................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit ............... `•` ' -.-....... Date ............__........ .I r Septic Tank (Specify Requirements) ....... .�.. ._1 .....�... ....... Disooso Field (Specify Requirements) . ............... . ... .. .. ........._. -j �� ...r....... c..... ...- ? .1 ......... ° : . .`---••per: ...�........-.. � � �...... {Draw existing and required addition on raver a tide) I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, Slate".Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner of 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 be orae a orkman's Compensation laws of California." ;anec� _.{1. . .s .*- ...f}. 2kS ... � f.7�5..... rs ��........... Owner r By ..... ......................................:............� ,t -... ....;... Title .:�7/... 9�? a. ................... (If other than owner) t FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY .-- - ------ DATE ..7'..• .••. ff BUILDING PERMIT ISSUED ......................... ....DATE ADDITIONALCOMMENTS .................:....... . . -- ...............-------..........-- ..... •• ..........................-...... . ..... .. ... .......................................---.......----...........-----..... ------------....................................................................---................. ._._.. �. .... ................. _ ...... ....... .-. __ ..... .. ... .... ......... Final Inspection by. ....................... .... .Date ... . --.. .(— EH 13 2!t 1-60 Rev. 5M� SAN J'OAQUIN LOCAL H ETH DISTRICT 8/7h 3M