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FOR OFFICr-USE: APPLICATION 77tT�� ATION FOR SANITATION PERMIT X15 .............. �U„ Permit No. ...73 -�6 (Complete in Triplicate) ""- 9 This Permit Expires f Year From Date Issued Date Issued �..,•:.:.:.:...... Application is hereby made to the Sal 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 Regulations: JOB ADDRESS/LOCATIIQ. ............... .7.0.1......-...Lu c'.L_l......14 I rz-yp....CENSUS TRACT ...................... [ " n Owner's Namer (H..G. .......... ..... :.....................Phone....._ ........ P Address ...............Q�..7�.r?.,...�r.�......�i_.1.:L.�?�[:. City .............................--•• --- ......---.............---.. ..... p-� Contractor's Name ........ ..�.:. 1''.1.C-0.t ----•......:.:.............:..........License # .... Phonelj.L.��. f Installation will serve: Residence ❑Apartment Hoy;eo Commercial QTraifer Court Q !t Motel 0 Other..-.L/�Y..1/ `'..�L.. . ........... Gcir t. � , . !/ Number of living units(......... Number of rooms ..X_...Garba a Grinder ..�.-.. lot Size /�.................. ........ ...... Water Supply: Public System and name .... ...- ........`cam` 5.: --.....-..........-.........•.........•...........Private Q Character of soil to a depth of 3'feet; Sand❑ eilt❑ Clay ❑ Peat Q Sandy Loam ❑ Clay Loam [] Hardpan ❑ . Adobe❑-TMIMaterial,- /. .... If yes,type ............................ 1 (Plot plan, showing size of lot,' location of system 'in relation to wells, buildings, etc. must be placed on teverseiside.) { NEW INSTALLATION: (No-septic tank•or seepage ,pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT :[ ] SEPTIC TANK ] Size................................................ liquid Depth ................ ......... Capacity .................:.. Type ..... .............. Material......... -- . ...... No. Compartments ...................... ...DDistance to: nearest: Well ....................................Foundation ...................... Prop. Line ...................... i s LEACHING LINE [ J No, of Lines .... ................... Length of each line -- Total Length ........... ................ 'D' Boz ...j}...:.. Type Filter Material ....................Depth Filter Material ........................................ Distance to neaiest:-Well Foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth ..::. f............. Diameter Number ............................ Rods Filled Yes [3 No Q ,. I Water Table Depth - :...........................................Rock Size ............ .............. Distance to,inearest:.Well.........................................Foundation .................... Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit# ..._. ... .................................. Date ... ........................... ) Septic Tank (Specify Requirements) ....... ...... -.................. ... ............................F. ......._... _.... - 2 /[ Disposal Field (Specify Requirements) ••-- Y -- - 4e-r. =-..... Jt•!�Q '"t ..... ---. ..�. .-Q .... ------,/- -----------------::---...--------------.----•------------------ . ............. ............... ....... ........................ . ........._........-------- ....... . ........... ...._.(Draw existing.and required addition.on reverse side) l 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." tSigned .................. . .................... q.........:'--.....::....................__:.......... Owner By ....................... f ct/.. .. ........ ..... Title .... �- ....-...:.................. (If of r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . •... .. t.7.:............................ ....................................................� )ATE .....� zS'.JJ ............. l BUILDING PERMIT ISSUED ...... .. ..-.. .__ .. ..P.-.S.._.'...:JS�..... ss`•lR ...... .d.. tta.._:a!!'. .w -.... D ........ .............. ...t....!.' Jr. .. . .......ADDITIONAL COMMENTS ._................_.......--...... ..... -- . -- ...... .. .- -.. . Final Inspection b (.... ...?.. ..:................................-......•.................... ...............Date ....� 027 SAN,JOAQUIN.LOCAL HEALTH DISTRICT._