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.W. • ,"" WQ," APPLICATION FOR SANITATION PERMIT -72- G Permit No. .. ..?..... (Complete In Triplicate) :.............................. Date Issued l ..... 7 ............................................ This Permit Expires 1 Year From 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 Regulatlons, JOB ADDRESS/LOCATION ......./Gr ._ ............LU...T! E.W�1L� .....kb............... CENSUS TRACT .......................... Owner's Name ....../U(1v ...... ! r� ��..........................................................................Phone Address .__.................................--...-....-..-..........-.._---....-.-......... ...-.........-..City ..yfj.J. .T�M1: ..................-_ Contractor's Name ..../Y r�...l�� ..................._..................License#y'77i7 .. Phoneme � �Src..... Installation will serve, Residence O Apartment House(3 Commercial OTrailer Court fR Motel O Other............................................ Number of living units:..... Number of bedrooms ..-.--.-.--.Garbage Grinder ............ Lot Size ........................... Water Supply: Public System and name ----------------------------------_.......................................................................Private Character of soil to a depth of 3 feet: Sand O Silt O Clay 0 Peat O Sandy Loam 1p day Loom O Hardpan O Adobe O Fill Muterlol ............ If yes,type ............... ............ IPlot 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,) 6 PACKAGE TREATMENT ( ] SEPTIC TANK( J Size................................................ Liquid Depth ........................:_c� Capacity .................... Type .................... Material----.................. No. Compartments .................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ........_............ EACHING LINE ( ] 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 ( ] Depth .................... Diameter ............... Number ............................ Rock Filled Yes ❑ No Ob Water Table Depth ..........................._...................Rock Size ................................ I al Distance to nearest: Well ........................................Foundation .................... Prop. line ........._..........X REPAIR/ADDITION(Prov. Sanitation Permit# .........`.................................. Date ..............................) Septic Tank (Specify Requirements) ...............�1�..1! �?..._�'p ...................»...........__...................._............................ cl Requirements) li�/7....-................................... �D rye h Re q ` Disposal Flela IS ........................ ................................. . .....................•------•................................... _............................................................ tie'_ ...,...3 (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 acemdance 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 ubigct to Workman's /Compensation laws of California." S,gned .. :: .f/+./..�1L. �Fs�.............................................. Owner By . ... ...... ................................................... ... . .. ........................... 7itie ...........................................................:............ (If other than owner). DEPARTMENT E ONLY APPLICATION ACCEPTED BY .._. ....... ..... .......:... ......... ...............,.-_.............. DATE ... - -..Z.,7....... : BUILDINGPERMIT ISSUED ............................................................. ..........................................DATE-. _ ...._.............--............... ADDITIONALCOMMENTS __ ............. ................................................. .... •............................. __.._.. . . ....................... ..................... ..------------.-----........... ......................... .... .... .............. FinalInspection by: ... ........................ ............................................... .......... Ell 13 2b1-60 Rev. 5M SAN JOAQ N LOCAL HEALTH DISTRICT 8/7h 3H