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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ ......_.. .-- � .. . ........ev.... (Complete in Triplicate) ................. Permit No. ..�....--..... - fj - This Permit Expires 1 Year From Date Issued •..... !.._. Date Issued ...1..-ay �y . 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: 1 �------- � CENSUS TRACT` .. . JOB ADDRESS/LOCATIO��.....�.._�m�....__�.__.......YL�Y1.R--...._._, . y-...... ........................ Owner's Name ...Q .. �.�C-..-. Phone ._ �r�6�3-. 7 ?. Address -.._ ............................ .. nl... .R �.P........... City _ Tt2� Q.h).----....-----•----........-/..................... Contractor's Name ....1),- ._5�_� R.1 _ rzti�....` .t�4c..................License # ------------------------ Phone ..... . .. Installation will serve: Residence'2,Aportment House❑ Commercial [❑Trailer Court ❑ Motel ❑Other ..._.nn...---''._._......................... .. i Number of living units:_..__..... Number of bedro ms ..!✓.--Garbage Gri der ............ Lot Size .��b-_ -...6. :��3•-•• Water Supply: Public System and name _. U - Q 1}LSC ? ••••-•••••.................Private ❑ Character of soil to a depth of 3 feet: Sand❑ It❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ` Hardpan ❑ Adobe ❑ Fiil Material _-------_-- If yes, type ..................I......... (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 f J SEPTIC TANK Size------ _rte:1.4?. .,� -`�------- Liquid Depth ... "...------ �. Capacity ..�.r ype . R - Material .. No. Compartments .... Distance to nearest: Well -t'1 AV-7.....................Foundation la............... Prop. Line _..--___-....___...... LEACHING LINE [ No. of Lines ......... ....... f __----- Length of each #ine......�!S.............. 'focal Length ._.. ........ D' Box ..... Type Filter Material . . --Depth Filter Material .... .(. . ...........•...._•._ ...... Distance to nearest: Well Found tion ....!.Pf. - - --•---- Property tine ------------- SEEPAGE PIT [ Depth --1-?- ....... Dia iter . ._____ Number .....I-----------------rt... Rock Filled Yes & No C] Water Table Depth . .Rock Size Distance to nearest: Well .... ................Foundation ..... d ... Prop. line ....... ...... REPAIR/ADDITION(Prev. Sanitation' Permit# ............................................ Date ..._..............................I SepticTank (Specify Requirements) ....................... --............---------------------------- .......................................--............................ 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 done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licew sed agents signature certifies the following: "I certify that in the perfarmance 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 Comofinsation laws of California." Signed . � � - .�5 ._ _.. 6.N- ........................ rnr� By ....................................................... .... Title ...._. r!!v'•. . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... •---•---.._... DATE _.. :,2 mac`` ` .............. BUILDINGPERMIT ISSUED .......... ........... .........................................••--•--...................._....I.......DATE ........................................... ADDITIONALCOMMENTS ...................................•-------..............--•-•-----..................---._...-•--------......._..........---.._...:........._....-----........ ----• ........................................•--•--................----------............ �-fr"- _ ................. -------------------------- ------....---• _... .... ------ ---- n. . .......... Final inspection by: ............r:!...... � . ...........-._- //-. .__ _- �� _-•----.Date . •-- SAN J AQUIN LOCAL H LTH DISTRICT `►. E. H.13 241•'68 Rev. 5M - _ -� _. 7/72 3 M - -�