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FOR OFFICE USE: _ 1 -APPLICATION FOR SANITATION PERMIT ' Oq-... ..4 .•r................. (Complete in Triplicate) Permit No. 3. .. .. V .............................................. This Permit Expires 1 Year From Date Issued Date Issued ,,...� .4 ;_ � Application is hereby made to the San Joaquin Luca`I�Health'Dast}ict fir`d` permit tok2oi struct and install the work herein described: This application is made in complier,c4,411thtounty•trd!nonce No. 549-and existing Rules and Regulations: a.JOB ADDRESS/LOCATION .- lst'/e?! .. = ......... CENSUS TRACT ..............:........... Owner's Name ...... ........... ................... .............. ............Phone ................................... Address - E ....... :f . I Contractor's Name ...... �✓.( - ...............L -.... License # /. .. Phone , -' .. ... Inst allatiomwill serve: Residence XApartrrlent Housed Commercial []Trailer Court 0 Motel ❑Other....................••......---•......._.... Number of living units:-.,/...... Number of bedroorftL;?......Garbage Grinder .. Lot Size .t,4�2 .................. Water Supply: Public System and name ......_.y. -- - Private --•-----_.. Character of soil to a depth of 3 feet: Sand LL Silt da �--'�'Peaat- Sand Loam Clay Loam P ❑-� ❑ Y ❑ ❑ Y ,. ❑ Y ❑ Hardpan ❑:"`.4obe,° 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.l NEW INSTALLATION: (No septic tank or seepage it permitted if public sewer is availabl'e wit 'in 200je'et3 PACKAGE TREATMENT [ ] SEPTIC TANK' Size.•. elC- s ................• -- Liquid Depth/- ..._-- Capacityl, ....... Typeek,_O� Material.'.". .41- No., Campartments .. 'p ............. V CISDistance to nearest: Well ..- .- 1��................Fovndation ..��.�__..__.. Prop. Line ��J.._......:... LEACHING LINE ( No. a# Lines ..... ............... fLengthY of each*line._ ---_-----_-_--- Total Length /;��...... i �A Depth Filter Material µ 'D' Sox '=. .. Type Filter Material lam__-� p /� •--••-•-• • -.. '^- Foundation _ ... ....� Distan a tc nearest: Well .., i�. . -•-.-'si. � .............. property Line fes._-•------.--• F SEEPAGE PIT ' Depthy Diameter k.,.9-2...... Number ....Z '....... .......... Rock Filled YesA No id Water Table Depth _..... ...........................Rock Size/ ! r Distance to nearest: Well ... ��r.......................Foundation .9:�,........... .Prop. Line .1�-.•--•--..-:__ REPAIR/ADDITION(Prev. Sanitation Permit�# . �an ------ ................. Date -_-_----........................-- Septic Tank (Specify Requirements) ............................... 1 el..------------ -------------------•------ .._................__._._...... Disposal Field (Specify Requirements) --••- ..............................%7:,---------------------------------------------------------------------------------------------- -------------------------------------------------•-•-------- ----------------•--...............---------------._..._....------••----.._..--•----------•---- ........... •----------- - . . ....................... w`(brow existing and required addition an 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 Rules and Regulations of the San Joaquin Local Health District. kiome. owner or ticen- sed agents signature certifies the following" "I certify that in the performance of the work dor which this permit is issued, 1 shall not employ any person in such manner as to become subiect to Workman's Compensation laws of California." . r , Signed - . `' g .... .................• -•--- ------------..(._.:._ . .. . - ,•-•-----••-•---•-•--•-•-•--- Owner � ..r 116 8y ................. �. ,............... T;Ne ,-Q� .....................................: (if at than owner F)DR DPA ENT SE ONLY APPLICATION ACCEPTED S -- -- ---- -- `��. DATE -. �:: ................ BUILDING PERMIT ISSUED ............. ......... ... ..-•----.....DATE ........................................... ADDITIONAL COMMENTS _ '� ................. ........•--- ......._.-.-------------------............_._.----.----.--.._.-.....----•--- ............................ .............: .. . .. ..:..... ----------- ••... FinalInspection by: ....:. ..... ... .............I....................... -----......-..Date .. -• ........... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3 M