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APPLICATION FOR SANITATION pERMIT IDA -05-6-6 ...........I...........:..................... (Complete in Tdplkotel Permit No, 7L-:jjZ "' This Permit Expires 1 Year rrent Deft Issued Dote Issued /!� .... T� 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 Na. 5:49 and existing Rules and Regulations: JOB ADDRfSS/LOCATIgN 3.. 3 5......H r Gv �J.�......... . .................................. {/�/ CENSUS TRACT »». AddressOwner's Name .._. . ..¢-/Ir�.Lgr. ..�r�r.• Fs. �7. ............................................... ............ .....Phone ... -•- - •-----------------...._.____..,City .._.,,5�`.-----....�-• ---- - _..—- Contractor sNome ------ ----{ -_ j Z •----�--------------•Pte _................» License # ........................ Phone ... . Installation will serve: Residence©APartment House Q Commercial❑Trailer court ❑ ..........._5.--- Motel❑Other---.............................. Number of living units.......(.... Number of bedrooms --7--Garbage Grinder ............ Let Size .....Z12_4 C..e sten Supply: Public System and name .....-•----•---••--•-•❑ Slit❑ Cloy ..Private ❑ CharacterSand of soll to a depth of 3 fait: Sa �._....ly ❑ Peat❑ sandy Loam 13 Clay Loam M Hardpan[k Adobe 0 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 INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK PQ Size.ld..+. SS..S -............._...... liquid Depth _..Y---........_.._. Capacity � r,Q..... TYPI ••• jW-- Material----� ------ No. Compartments Distance as ..�nearest. Well LEACHING LINE No. of Lines -.-. _.--------Foundation ../!?--• Prop. Line ... [ ] -.........._. -- length of�leaccc h line...f.d'L............. Total Length ../._Z.b.�...»... _. D' Box -7422 .. Type Filter Material .f/.:c1.:.......Depth Filter Material . )-:?..'. .............-...........»..N Distance to nearest Well .._r?A............... Foundation .../�.............. Property Line f SEEPAGE PIT � ( 1 Depth ..ax---S--...... Diameter �c3..... .. Number -•----�--................ Rock Filled Yes. } No Q Water Table Depth ...../..S.'D............................._...Rocktl- Distance to nearest: Well ..../.." ..........................Foundation ..� .P......_. Prop. Line ....... '. REPAIR/ADDITION[Prev. Sanitation Permit# ............................................_. Data ------------------...._.....---► Septic Tank (Specify Requirements) _.. ............_ ......._....._..................... .................. Disposal Field (Specify Requirements) Q .................. ---------------- I ------------- - - - - -- ... - -- �j ----------------------- - ---,---. (Draw existing and required addition on reverse side) � • '••"•'»'-'•'----- I hereby certify that I have prepared this application and that the work will se 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 i e performance of the work r which this permit is issued, 1 shall not employ any person in such manner os to becom bjectbject to Com sation laws of California... Signed ----------------- _.. .. - Owner By --- Qf other the r ........ Jitle .. - _... .. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_... --_ BUILDING PERMIT ISSUED .... .......................................................xx.€x _ - DATEJO.�./, - 7.C�---- ADDITIONAL COMMENTS -. . _ - - - DATE ...........----------------------- ........................................ .................................. ...... . -- .. Final Inspection by -/. F �< . .-.. - --•-----------......... .. Elf 13 21a 1-6f3 lieu. 5Af - _ _. . _. ... . . . . Die =11...�� ..._ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M