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wo- FOR OFFICE USE: 1PPLlCATION FOF, SANITATION PEF °T _ . J -73-5�� (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 ADDRESS/LOCATION __ _ LCPPI d.-------0&----- _ _-_-. ----------.--.CENSUS TRACT --- ---------- Owner's Name .-.-./3C20---------Att ----------------------------------------------------- ---------------Phone ------- Address .---------6r4/r � -----------------------y-__------------^------------- ------------- City - --------------------------------------------: Name _{J`��.-S��?----/--AA1i _----------------License # l-`T-/ 91-:7---- Phone �rr+�-'-�5- .. Installation will serve: Residence (X'f Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other Number of living units:----1------ Number of bedrooms -1----.Garbage Grinder --------- Lot Size P-1witelaS-.--_---__-._ Water Supply: Public System and name ----------------- -------------- ------------------------------------------ ------------_--_-----Private [$' Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam �❑ Clay Loam g'[ Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i r PACKAGE TREATMENT [ ] SEPTIC TANK t4 Size--17-,Y-.y '� - Liquid Depth _a0V r� Capacity Maz1.X'✓�/-__ TYpeP jL�Materiak0A6 No. Compartments o(- -_-------------- 0 Distance to nearest: Well - .`_-_ -----------------._Foundation -!t`-------------- Prop. Line -------.---__. \ LEACHING LINE Pe No. of Lines---_-L----------_---- Length of each line.-JOQ_-.._-.,-___ Total Length ------------------ 'D' --.-_..-_.---_'D' Box N-0----- Type Filter Material R-JCe------Depth Filter Material -rl-'9----------._.---------_------.---.- Distance to nearest: WellJ-0-____----_�- Foundation s__._-.._-.--_ Property Line �i _.-.- SEEPAGE PIT [x] Depth -.,cr.,/-- -_---- Diameter �z..__._ Number __1_--.----__---.--. -. Rock filled Yeses No C1i / Water Table Depth ----.--�E1.4---------------------------Rock Size -� -1 ---------- t E Distance to nearest: Well -_ _-_.------_-_.-----..Foundation --------- Prop. Line .f----_-------. 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 r_ 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." .. Signed -------------- - Owner 4 — Title -- (If ther th owner) .. F9f DEPARTMENT USONLY J APPLICATION ACCEPTED BY1. - - - ---------------------- -------- DATE _. - ` BUILDING PERMIT ISSUED -------------- - — ---DATE ------------------------------------ ADDITIONALCOMMENTS ------ -- ------------------------------ ----1-------------------------------------------------- - --- ----------- ------ -- ------ - ------ ------ - ----------------------------- -- ---------------------------------------------------- -- L � -- - - - - - Date ----------------------by----------- ------ --- ------- ------ - ------- --- - ---- � ----- --- _ - - Final Inspection : ---./-- -- ------- ---- - - ----------------------------- ----- - ---------f --- --- / SAN JOAQU LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M