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ftlCE USE: APPLICATION FOR SANITATION PERMly Permit (complete In Triplicate) Date Issued .............. ............. � this Permit Expires 1 Ysar From Date hsued .... Application is hereby made to t`Son Joa Joaquin Local Health District for permit to q p construct and Install the work herein described, This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIN Owner's Name .... `' ? ..... „.............................................. .......Phone X P " Address "l.-• •�/ City Contractor's Name .... ....License 'fg _21.... Phone Installation will serve: Residence Apartment House fl Commercial[]frailer Court €] Motel❑Oilier..... •---------------- -- Number of living units------- Number of bedrooms .... -.----Garbage Grinder ............ Lot Size ----- ._ rh ....... Water Supply: Public System and name _....--•---•----•.................................. — ...............................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cfay 0 Peat❑ Sandy Loam)a,. day Loam Q Hardpan 0 Adobe 0 Fill Mcterlal._..........If yes,type..... ....1....... O (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be pkmd on reverse side.) NEW INSTALLATION: (No septic tank or see a pit mitted if public sewer is )available within 240 feet,) ` PACKAGE TREATMENT ( ] SEPTIC TANK Size...........,1.k4'_. k:-1. ....... Liquid Depth .......................... Capacity hlzay....... Type fc jk._.. Material..0,o7rz-,-t No. Compartments ....�............ Distance to nearest: Well .............. Foundation ...................... Prop. Line...................... LEACHING LINE No. of Lines ........ .......... Length of toch line......I47e............. Total Length 'D' Box .J....... Type Filter Material --- Depth Filter Material ............................................ Distance to nearest. Wali ....,.a7"?1 ` - Foundation ........................ Property Line SEEPAGE PIT Depth .Z ' ' p ,�......__.._ Diameter _: �...;... Number ..._.,.�.................. Rock Filled YbsO No Water Table Depth ........... . -•.- .........Rock Sire -------- /A� .... ............ Distance to nearest: Well ......�. r:_ '..........Foundation .................:.. Prop. Line ...................... E REPAIR/ADDITION(Prev. Sanitation Permit# ............. Date................................... SepticTank (Specify Requirements) .............................----••-•-------..........................................................:........I...................._....... Disposal Field (Specify Requirements) _________________________ ___________________________ ..................................................... ................................................................-...--................................-........I..................... . (Draw existing and required addition on reverse aide) 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. Hems, owner or licen- sed agents signature certifies the following- "I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ....... ......... -•---_..... .................................. .............................. Owner O __. ...... Title .... .......... .. (If other than owner) FO4 DEWTAIMIT USE ONLY APPLICATION ACCEPTED BY ,. ..... DATE . -------•----- I BUILDING PERMIT ISSUED ........ I} AT ADDITIONAL COMMENTS ._!C.! 7t�1/l�c!� Q11 .... _ 1 .�,,A .. ... .... ...../G .......................................•-- ...................---•-.. . . sF.tr �• Wit' 1. *-Q�.71 >? 1..aT.-_ dJ'tri.4i!`. ..... ..� ......... . -•.......................... + C. ,P1h./fAEi . .. . ./rlL �'�`/ t1 f Ll�1r..i'??`!'d r ..<tt Fina! Inspection by: ............. .....-................................._.._................ ................Dole ...... /..-_- Z _-- i3 2!� 1-6Fi lieu. { SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h