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FOR OFFICE USE: ' APPLICATION FOR(Complete in Trip SANITATION PERMIT Ra "-- _ - - Permit Na. . � -- �----- '� �-� Mate -- - -/----7,�--- -- __-- This Permit Expires 1 Year From Date Issued Date Issued 1�- - � 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 .__- S T. "-l/?-7-4,_ -4/16'!-` Tom, ------ -.-----CENSUS TRACT ------------ Owner's Name _/ _Lr__ t' /+t_O.2a---------L�ht.-gra----------- --------------------------------=- -------------------PhoneIYp-IV�---------------- Address ----- ----------------------`7-----5%= L/s Th /ru�0------- F -----------------. City �`� ------- �//� / i IF "Contractor's Name ------- 1 — F � � -------.License # - Ga�YO--- Phone F ' Installation will serve: Residence [Apartment Hduse❑_Commercial :❑Trailer Court ❑ Motel ❑Other -=--------t--------------------------------- t Number of living units:-----/----- Number of bedrooms .__3_°:...Garbage Grinder _A -___ Lot Size /SZ--------_______ ; Water Supply: Public System and name _L E°'__-___ ---- 717_IP�t -F```'' -'`--' -��`'f--------- -- = Private ❑ - - ---------------------- Character of soil to a depth of 3 feet: Sand'E] Silt Clay ❑ Peat❑ Sandy Loam)Zr, .Clay Loam E] Hardpan ❑ Adobe'❑ Fill Material ------------ If yes,type -------------------- (Plot ._.- ------------ ---(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 seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT {*--SEPTICTANK [ ] Size------------------- _- Liquid Depth _______________.____,._.. I. Capacity _:�x_�v Tfype _ � Materia!______._C' ___ No. Compartments _____._`L-_..______ Distance to nearest: Well ----__-__*- Foundation ----------/__________- Prop. Line -----------------_...... LEACHING LINT= [ ] No. of Lines ------*3-------------- Leng'4(of each line-�S''-yam_'3.f___ Total Length -----/. �......._... D' Box .-- --�_-_-- Type Filter Material ____________________Depth Filter Material ------:---.---••----.-•----.--•------._-__-- Distance to nearest: Well ------ -------- ;Foundation ------------------------ Property Line. ________-_______-.------ SEEPAGE PIT [ ] Depth ____ -------------- Diameter ________E______ Number ------ --------------------- Rock Filled Yes '❑ No .0 4 k Water Table Depth ----------------------------------- ------ -----Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation --------- ---------- Prop. Line -------------------- i .. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------------------__J Septic Tank (Specify Requirements) --------------------------------------------------------------------------------------------------------------• ------ Disposal Field (Specify Requirements) ------------------------------------- -------------------------------------------y--------------------------------------------------- ------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------••--------- -------------------------------------------------------- ----------------------------------•---------------- --------------------------------------------------------------------------------------------- E (Draw existing and required addition on reverse side) 1 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. Home 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 such manner as to become: abject to Workman's Compensation laws of California." Signed ----------------------------------------- Owner e By --------------- - _. !' `- �� = Title ----------------------------------------------------------- (if oth than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----__ 27-7_-`-4�-------- ------------ DATE ----42=0 _-G '------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------- ------------------------------ -------------DATE ------------------------------------------ ADDITIONALCOMMENTS ------------------------------------------------------------------------------- ---------------------------------------------------------__---------------- ---------------------------------------------------------------------------------------------------------------- --------------------------- ------- --------------------- ------------------------------ -------------------------------------- ------ ------------------------------_------- Final Inspection by: ___-- --- -` Date ---2_- _ --7f]------•--___-_- ------------------------- ----- ----- --------------- --- ------ --- ---t• SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.