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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT d IComplete In Triplicate) Permit No. . This Permit Explres t Year from Date Issued Date 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 madeincompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION :---.. .�a.�. -•--. -.,�7 CENSUS TRACT ......... l h/...,................... ..... .. ................ l Owner's Name . .................... L .t_. Q�21.. .I-.............................................................Phone /....... Address ...._... ... pules.. Cly'! ' _ ....................City ,l......... ............... ........_... �7 Contractor's Name ..................� i l. .�2ts f-_ ._'"�. Q.?Sl', �P ...Litense # .�` $_54e-4(3.. Phone 44' --.��1.. Installation will serve: Residence,XApartment House{] Commercial❑Tra€lar Court ❑ Motel ❑Other.... ................................... Number of living units:...-...... Number of bedrooms .......Garbage Grind r 'PtSlze s4 `4 e Water Supply: Public System and name . ... . ..� ....................Private ❑ .. ........... Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Pea ❑ Sandy Loam ❑ Clay Loam,] Hardpan❑ Adobe O, Fill Material............ If yes,type ............... ............ (Piot 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 f ] Size.....................•--------.......... ... Liquid Depth !" Capacity .................... Type ----------.......... Material-----------........... No. Compartments ...................... J Distance.to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ---------------------_ Length of each line----------------------....... Total Length ............................ 'D' Box .........._ Type Filter Material .................:..Depth .Filter Material ............................................ � Distance to nearest, Well ------------_.......... Foundation ..... .............. Property Line ...................... SEEPAGE PIT ( ] Depth .................... Diameter ................ Number .---_-.--- ......... Rock Filled Yes [3No C _. � Water Table Depth ---.......................... ..................Rock Size ...........---•---•---•-- ...... Distance to nearest: Well ....................:...................f=oundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ------------...._.._..----.................. Date .................................. Septic Tank (Specify Requirements) -----. kms- _ • -------• - ............ ..... i3is sal Fiel (Specify Re irements) .._...... -- s;,,,la� tT,�-;. �..�._._........ 7A ----------- ---------- j� - - (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. Nome owner or licen- sed agents signature certifies the following: "I certify that in the p ormance of the work for which this permit is issued, I shall not employ any person In such manner as to beta a subject o arkman's Comp nsation la of California." Signed ..... a LJ---s -_ - �-:� - BY ------------------ ------------_.. - ..--- -- ----- _ .._ _. Title .. (lf other than owner) FOR DEPARTMEN USE NLY APPLICATION ACCEPTED BY ------ r - '�G`-- ----.-•- DATE ..c�=a� `7 7------- - ;..: BUILDING PERMIT ISSUED -- _.-•-- ---_-- .... .. DATE . ....................... ----- ....._ ADDITIONAL COMMENTS ......Z _._ -.�-..--. -- .._ ............. ........ ... ...................................... ------------- --•---------- ------------..... ....--------------------------------------------.-------------------------------- -•-•-----•---------•------------------- ----------------...-.....I---- ............................ -----------•- ••------------ ._ - ---•----•-••-•-----••-----•--•-----••---•---•-••................................ ............. Final Inspection by: ----- . • . ... ... ........... ....•----..._..._..........---•------._.....-- -----------•----.._...-..---._Date ........ ...---- -7----.........---- 13 2t� 1-613 11ev. SAN JOAQUIN LOCAL HEALTH DISTRICT (3/7h 3M