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FOR OFFICE USE:- %PPLICATION FOR SANITATION P6 .IT -. . _.._.... (Complete in Triplicate) Permit No. " -.--- --__. --- -_ This Permit Expires 1 Year From Date Issued Date Issued Application rbedis hThis ereby made to the San Joaquin Local Health oun Istria na a i � j�� in and install the work herein s: y qC permit to construct g ulesV s: JOB A DIRESS/LOCATION ication is�made in com li ce i County Ordinan�e�lo� tM.1 existing TRA _._.............._... Owner's Name t�Y�.y-_ .La-- IG / Phone ----------------------------------- Address ..S S �- _L�LLy�L .. City FQ S_�1 Z3�ji �� (� /......................................, Contractor's Name -_. --------- City _1.J2gJ_--`.�------_..__................License #I).(13C1 Phone d 3:�4?rJ..7r' Installation will serve: Residence ❑ Ap//artment House❑ Commercial [frailer Court ❑ Motel ❑Other . ......_.__ Number of living units:--------- .. Number of bedrooms ..__ ----- Grinder _.----- --- Lot Size ._............................__...___._... Water Supply: Public System and name .------ ------------------------------------------------------------------------------------------------PrivateR Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam J] Hardpan ❑ Adobe [B 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 PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size..J .J�_/ _../ .? Lquid Depth �.Z.,_.__. Capacity .LtS1`+ Q_ Type Cd_7_Vd,)X1MMaterial-------_------....... No. Compartments ----2---- 51. ----------- Distance to nearest: Well .__6�f-_.___._._..._Foundation __..., -------- Prop. Line ..__iS........_.... /� 4 LEACHING LINE [ J No. of Lines ..._y___.__-._. Length of each line____{_ ------------- Total Length ._2 --'.__.___...__ 'D' Box ------ Type Filter Material ----------- --------Depth Filter Material --------......._...___..__....___.___.. Distance to nearest: Well -__---_-------------- Foundation ------------------___ Property Line _..__............:.... SEEPAGE PIT [ ] Depth _._____------ Diameter ---------------- Number --- --- __ ---_._------- Rock Filled Yes ❑ No _ Water Table Depth ----------------------------------------------Rock Size -------------------------._- Distance to nearest: Well ........................................Foundation .____...__..._....-- Prop. Line _....._._.._._.__...__ S\ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .-----------..--------------------) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) (Draw existing and required addition on reverse side) 1 I hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject to WT__ s Compensation laws of California." Signed ..----- ----_.. - - - ------ ------t--- ----- Owner - -� �By �� --- � ,>� " - Title - - (If other than owner) " LFOR DEPARTMENT LISEONLY ' APPLICATION ACCEPTED BY /Z........ .......__ s L-_. DATE _.IL_ _f'_..__ BUILDING PERMIT ISSUED - - -- - -- ------ - �--------------- -DA -- ---------- -- ---------------- ADDITIONAL COMMENTS -------- ------- ------------------------------------------- --- -- ---------------------------__....... - - - - -- - - --------------------- ------- -------------- - C - - ------------------------------------------ — - ------ -- �fZ^9 -------------- -------------------- finalInspection by: ---------------------------------------------- ......... .......... -- -G- - -- ----.----Date -- -- - -- `- t '-----.. . L SAN JOAO I J AL HEA Df RICT E. H. 9 1-'68 Rev. 5M