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FOR OFFICE USE, I + a WLICATION FOR SANITATION PERM N' � F (Complete in Triplicate) ' Permit No. __:)L. , ........... This Permit Expires I Year From Da _.....- ........... ......... ...... ............ p to Issued Date Issued :..L�- 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 Ordfinance No. 549 and existing Rules and Regulations: f JOB ADDRESS/LOCA5ON _�-�__-- .. -- �/?t! �.. f. .........................CENSUS TRACT _.. / ._.a ........................Owner's --------------- Address ...... ..e_�Jf,_.. .�_. C rj .r--------------- --- itY . . Contractor's Name ..... . .. .....�..,.._.:..._`...::. ......... ' '' _..•ch+h-r, n License # . i .. Phone ..... . ...... " Installation will serve: Residence �'Apartment House❑ Commercial ❑Trailer Court :❑ Motel ❑ Other ............................................ Number of living units:.... Number of bedrooms __ ------Garbage Grinder _....._ Lot Size ------------------- ... ------._.:., ...... Water Supply: Public System and name .-----L-- - - �C.,� d`t -------------------•------. ..-_--_----_-.--_.-...-..-.--.----Private ❑ Character of sail to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam UJ/ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, {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,) \'# PACKAGE TREATMENT [ SEPTIC TANK [/� Size. /'.?'�'-q-r1• - ....... Liquid LI uid De tJt q p 7.•--.... * Capacity /,�c'�w I ' Type ._ Materia1....�'"'t,4L.... No. Compartments .fir. (� . ............... Distance to ne rest Well ..........1r!�. ......... .. . ....Foundation ......!e.......... Prop. Line ...a�..�.......... LEACHING LINE [y]' No. of Lines ....... ............. Length of' each line._.._. 0."............ Total Length .a a.,. .............. � w ,/•'. - 0,0 1 'D' Box . �..___. Type Filter Material _____ _____________Depth Filter Material --------/Y------- ------ -.-__......-... r ....... Distance o nearest: Well ... 1. .._..__. Foundation _.....- P_j....., property Line ....... • SEEPAGE PIT [ J Depth -..--.-- --... Diameter --------------.. Number ........:.._._.............. Rock Filled Yes ❑ Water Table Depth ..........Rock Size } Distance to nearest: Well ................Foundation ...._. ---------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................... i. Septic Tank ISpecify Requirements) .---..'..........................................-------- .................................. ............ ti Disposal Field (Specify Requirements) ---------- -------------------------- ----- ---------------• -------- ------- .. -- ............................... ......... ........................... --- ---- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 as to become subject to Workman's Compensation laws of California." Signed ............. dyl......... Owner [if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYu��•✓�...................... . 7 / . .--------- �---------•- -•......---.. DATE ......"�.......�....................... BUILDING PERMIT ISSUED ............. •----------------DATE .. --------------------------.... ...... ADDITIONALCOMMENTS .................................................. ..........................................:......_................. ........................ ............ ......... .................... - --------------- -------- y. ------------- ......... ........... ---..............., ........... .............. Final lnspecfion by: . _-. :� t� ✓ . - -------- ..Date ....'...": ..."7,1........................ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M