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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................. Permit No. _..��.��_.. � (Complete In Triplicate) �Iy.3C2....................... ........................................ 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 existingRules and Regulations: 0 r ,E . 14-c ��Y, •/ �+_ - iy� �4 w oa-(_3 J08 ADDRESS/LOC�T10N /.L'----Yl/ _ .� (,T%��S i......... ._ �1 �t ...CENSUS TRACT .......................... Owner's Name .... .. . ... ........... ��I KP. ...................... --._........ -•----------•----..__.._._......Phone ... ............................... Address ._..__...L!Q../,�!•--- ,�' RS 10--- City S �R. ................................................. Contractor's Name ..--/��or..- .. .*, .7a&-0"---------------------------------------License # Phoneol&:7991 /z....... Installation will serve: Residence 0 Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other ............................................ Number of living units---------._._ Number of bedrooms _3-----Garbage Grinder/c-i---- Lot Size ......_..__ ......... Water Supply: Public System and name ..:........................... .•------------••------........_.._..........-------••--•--------............Private a Character of soil to a depth of 3 feet: Sand❑ Silt❑ - Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 10 Fill Material ............ If yes,type ---------------_____________ (Plot plan, showing size of lot, location ofsystem 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 PACKAGE TREATMENT ( J SEPTIC TANK�M Size...4,:k-..9............ .... ........... Liquid Depth . ....I........... Capacity ..._ Type.e4�4i.OFMaterial...................... No. Compartments --I"--........-- l'� Distance to nearest: Well ......04'9 ...................Foundation ...IIP.......... Prop. Line a r:'000--_-•--- LEACHING LINE JkJ No. of Lines ......a'.............. Length of each line.___ __-_--........... Total Length ....... :D'-Box.�/id-�,. 7 s� Type Filter Material` ...Depth Filter Material.�..................................... � s Distance to nearest: Well _.�Q..----•--------. Foundation --�............... Property Line ZoO................ �7 PC Depth . Diameter 5... Number _____-Z . Rock Filled Yes No P �p..........-- -,� -----�-......fes ,Q []� Water Table Depth ----�e,f .................................Rock Size`--' ------------------ Distance --- ----• ----- Distance to nearest: Well ...../� ......................Foundation _.. . ._. Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ) SepticTank (Specify Requirements) ------------------------------------•----••-•---------------•--•--••-•---------•------..-_.-..-----------_---------•-•----•----- ........ DisposalField (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. 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 Compensation laws of California." Signed .................. .....f----- ._._. .... Owner _ .---...... Title :L4Y 40�"-:-'............... (i er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... . . .... . .. ................-•---•---•--------.........-•-••............_..... DATE ---•-- .2*-------- BUILDING PERMIT ISSUED ....... .....DATE ........................................... ADDITIONAL COMMENTS ....•••• .................•---•-_.. -•-••-_.... - ._...... ................................. Da Final inspection by: .. ..._.._-.. to .-_./_. ._. .. . •.. .................. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/72 3 M