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4 FOR OFFICE USE: APPLICATION JOR `SANITATION PERMIT ...................... Permit No. (Complete in Triplicate) _ ..........:..... ......................... ........ T This Permit Expires 1 Year From Date Issued Date Issued .. ......7 t 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 ......+ _.s3.. _..��.__--- --._..... �. 7-le N_ ........CENSUS TRACT .......................... Owner's Name : L�:� ......a/.. 7....._Y.�-S-7. ..............•----------.....................- •-•--------....Phone's' �/ .. i eS'?-0 . V-----------------------•-- AddressCiry Contractor's Name ._.. LE,J d { ............. i.......................... # •--.._...._............. Phone ..•..•... Installotion,will serve: Residence VApartment'House❑ Commercial❑Trailer Court 0 � Motel ❑Other _..-----•- .................... y.! Number of living units_____________ Number of bedrooms --___.Garbage, Grinder .��-"lLot 5i`ze...... &em.�................. Water Supply: Public System and name r..( _......................................Private M— Charactee of soil to a depth of 3 feet: Sand❑,AgS;lt❑'� Clays ❑ Peat❑ nay loam Clay Loam Hardpan ❑,4dobe,❑—Fill,Material .......... If yes,type ........................ .... � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) { NEW INSTALLATION: (No septic tank or,�epage pit permitted if public sewer is available within 200 feet,) k � r PACKAGE TREATMENT [ } SEPTIC TANK f;} Size.............................t---------------.-. Liquid Depth .......................... Capacity_ Type _ Material.._.....___`. _-.- No. Compartments ........... T e ....._ Distance to nearest: Well .............. ...........�.....I.Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines .-.......... Length of each line........... ................ Total Length ........................ 'D' Sox . ---------- Type Filter Material ....... .........IDepth ;filter Material ........................................... . Distance .to nearest: Well ................... . Found .. gat n ----I.................... Property Line ._._..................... i Rock Filled Yes No SEEPAGE PIT 7 Depth ._ ZS._------- Diameter . 3.3_-•---- Number. ----...--1............. . .. Oj r ID Water Table Depth -----••-•--- 12.1.........................Rock. Siie .......Li ................... D;stanceto nearest: Well .......1_ _f_........�..........Foundation ....../.Q.......... Prop. line ......... ' REPAIR/ADDITION(Prev. Sanitation Permit ................................. --•--.. Date ............................. ... ......__.._.__....._. -- .) f Septic Tank (Specify Requiremen ts) ------------------• ------------------ -----------_------_ ....._....._..,•---•-------------•� .-- --------•-- ------ f 33�fS � Disposal Field (Specify Requirementsl ..__.__._..�-----•-------------- ------ ' ....--- •-. ._..-- rr.T s ------.......-------------------...----- ----------........------•. ........ ................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will bte done in accordance with�San Joaquin County Ordinances, State Laws, and Rules and Regulations 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 not employ any person in such manner I as to become sub'ect t orkman' nsation laws of California." Signed :__ ..................--•-- --- Owner (If other than owner) ` 0 J' r 0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......I --- ..L..... ... .. . -. ..�.'0 lit ) ................. DATE ...... ... .�--g..... .......... BUILDING PERMIT ISSUED ............: ...-----. .... DATE ..-- --•-... .... . ADDITIONAL COMMENTS ------------------------------•--------••..._.......J.. ........ - -- ------------ -- ---. ............ ..............................1............. ::::::::::::::::::::::::::::::::::::::::::::::: _.....------- ........��.. �: . .. .....� :::::: j: ::::: ` ::::::::::::::::::::::::::: ...---- ............................ �^: �:: -- = - _ _.............................. . Final inspection by: .. .........................Dae .. 1 ... ...... . ..... _ r SAN JOAQUIN�- L HEALTH DISTRICT t E._Fi:L3 241-'68 Rev: 5M 7/72 3•jK