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E FOR OFFICE USI'c:. Y' APPLI -ATC ION I OR SANITATION PERMIT L ` - - --------------- ---------•-------- _-.�_�`� (Complete in Triplicate) Permit No. ------------------------------------ This Permit Expires 1 Year From Date Issued Date Issued 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 A DDRA LOCA ION --------- -�:- ' r E S S TRACT -----6 Owner's Name ------- one j Address w '-ATH-ROP----------------- City .L1�-F-H-ROI�---- ------------------••----------------------- Contractor's Name _ Ff1L1- -----�0A[ -. -CO ---- # ?. - ---- Phone --- _ ` --f-- Installation will serve: Residence �partment House❑ Commercial ❑Trailer Court ;❑ - Motel ❑Other Number of living units:_.-__/----- Number of bedrooms --------Garbage Grinder _____ / --"Lo`t Size --; -- -O--X--��-------------- Water Supply: Public System and name ---Lam-w—P----- �/�} / 1__ �_� -------------------------'Private ❑ Character of soil•to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material __JV_0_ 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 seepage pit permitted if public sewer'is available within 200 feet,, PACKAGE TREATMENT [ SEPTIC TANK j Size___4j_/_J1---a--K ----------------------- Liquid Depth _- - ___`�-______ .. Capacity l © TypePV_617_b-_ Material 156A No. Compartments -------•+��. Distance to nearest: Well ____. �L' ____________Foundation _10_`-�___-_ Prop. Line _.�_�_ ...___ LEACHING LINE 411 No. of Lines -----2:? ------------ Length of each line.____.��_-----_-_____ Total Length ,____/�0______._--_ 'D' Box x- / S Type Filter Material R Depth Material ____� ________________________ ________ s 5-- � Distance to nearest: Well __._Cr__N-______ Foundation ___fD__-_' -_---- Property Line ----',..�_--_____f-...... SEEPAGE PIT [ ] Depth ___ ____________ Diameter _______________ Number ---_ ----------------------- Rock Filled Yes ❑ No ED f Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundafion --------------------- Prop. Line=----------_--__--_. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (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 f 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 as to become subject to Workman's Co ensation laws of California." Signed _- c4 Q�r' ------------ Owner By --- ------------------------- -------------------------------- ---------------------------------------- Title ----------- ------------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY L f APPLICATION ACCEPTED BY - 1 R ` - ---------- -------• DATE ----- - CI x ' ------------ BUILDING PERMIT ISSUED DATE ------------------------- COMMENTS -- - --------- ------------------------------------ ADDITIONAL ---------- -- ----------------- --------- ----- -- -------------- = -- ---- ---- , ------------ - ----- ---- - -------------------------- ---------------------------------- - -- ------ -------------- ---- --- - -- - ---- ----- -------- ----------------------------------------Auwbr fir,-, -------- Final Inspec - by. `�C�---- -- - --- - ------ -- -----------------------------------------Date ---- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M