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FOR OFFICE USE: APPLICATION FOR SANITATION P''MIT :: .... ._.... ..._ G .aa Per No. ...7... ..... .. . (Complete In TripliwM) ........... This Postleft Expires 1 Year From DaN Issued Dais Issued .. Application Is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. This application Is made in compliance with County Ordinance No. 589 and existing Rules and Regulations: FiT JOB ADDRESS/LOCATION _..... ........ ....W6�.....................f-::.p �p.........................CENSUS TRACT ................:......... Owner's Name ...... ...............L.f!FkG°L�13. Phone ....... . . ..... . .. .. ... ....................... .... ... Add ..........flo...gl..... ieELc!i� .....................Clfy ... .r ............................................... Coraractor's Name ......, r/ fr/ 1. -..__----------------------- - . -------: .... 11i.....License o�r�s�z._ Phone ........... Installation will serve: Residence 0 Apartment Houses] Commercial []Trailer Court 0 Motel p Other ............................................ f} G Number of living units:....... Number of bedrooms Garbage Gri der Lot Size ....,1� . ...................................... Water Supply.• Public System and name .--.-- _ ...................................................Private Y 1OG-- .... EJ Character of soli to a depth of 3 feet: Sand 0 Silt❑ Cloy Q Pact 0 Sandy Loom 10 Clay Loom ❑ Hardpan❑ 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 OMALLATIONs (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ PACKAGE TREATMENT ( ] SEPTIC TANK{ ] Size................................................ Liquid Depth .................... . ' Capacity .7.................. Type .... .............. Material.................... No. Compartments Distance.to nearest: Well ....................................Foundation ...................... Prop. Line .............I......... LEACHING LINE [ J No. of Lines............... -. Length of each line..................... ..... Total Length 'D' Box ............ Type filter Material ....................Depth Filter Material ........... ............................... Distance to nearest: Well __.................... Foundation ........................ Property Line ....................... SEEPAGE PIT [ J Depth .................... DlornoW ...... ......... Number ............................ Rock Filled Yes (] No O r Water Table Depth .........._._.................................Rock Size ................................ 't eo Distance to nearest: Well .....-._..............................Foundation .................... Prop. Line ...................... WA IVADDITION(Prov. Sanitation Permit# .....-•--- Date ..................................) Septic Tank fSpedfy Requirements) --------------•� ----y-----........../�.L.....:.�i�r�l,�:...T......................_.._......._................. t Disposal Field (Specify Requirements) .... 1< ..... ...... .............................................................. ..._.......... .. . ._ ..... .....--•.............................--•----•--------........----•--••--------._.........----.........__...................................................... ------------I....... ........... ' --- . ............... --.------------.._...••------•------......-••--•--•-------.........-......................__.......................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Lows, and Rules and Regulations of the Son 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 pars" in such manner as to become sub)e a W/ km 's Compensation laws of California." i' Signed -l/t•. . .r...s!J ............ ............. .. ......................... Owner I By . ... ...................... ............. ....._...------------------------- ....... ............... title . _. �1 (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY G✓ . . DATE ................:. BUILDING PERMIT ISSUED ............ . ..................DATE ....... ADDITIONALCOMMENTS ..........................................................................................................__....._._....................................... - ._ ..._...................._...................... ......................... ............ ...... ----- . ..... .I..... ....... ...... ...........-..._........... ................. -------------....................... ...................................... ...__ . ._.................moi./. .. .. .. ..-- - - Final Inspection b ............. . ........... .. . ..................Date ...-- . EH 13 21; 1-68 Rev. 5M • N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M