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rux Ul-mu: Use: APPLICATION FOR SANITATION PEP'{1T >f Permit No7�..-..'. ` (Complete In Triplicate) ""-'""-' . ...... ..................................._..... This Permit Expires 1 Year from Date Issued Date Issued ..7. ..Z L Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein c',scribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: IN. JOB ADDRESS/LOCATION_ - I . Gtr... . .._ ..�'JQ... ... . ." ./f..�rT 2...1..'`.:T.CENSUS TRACT ......_. _.............. Owner's Name ..- ......... .... ........... p .l .l...�.ff... .................._ .....Phone ...._... .......................... Address y.y�.. J/ -,. Ci �. ........ . pp p .................. b"' Contractor's Name ...........l0* ......�t�Q..�...�..................Lice nse # � .�/T�,!`.•Phane ...... Z>.r— Installation will serve: Residence alkpCiriment House 0 Commercial❑Trailer Court D („ Motel ❑Other ... Number of living units:..... Number of bedrooms ...... ._..-Garbage Grinder . .... lot Size _. .�� '.......r Water Supply: Public System and name -------...............---------------..................._.. .. . ....................._.....Private [(}i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ 7` Hardpan ❑ Adobe Fill Mcterlal Wo. 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 Size.....1._�_/ ,�/ / [ ] i 'J' IJI_ ' /��0../.t.�........ Liquid Depth .o� ........... ... --_----_- Capacity/ Type ..��rG/�`�te'rialro_JYiL f No. Compartments ..� ..._........r Dis nce to nearest: Well ....... ..�..................Foundation ..�A.....__...._. Prop. Line .. Z......... LEACHING LINE [ No. of Lints..l. ..y�..l�� length of each line....f61.9..�....... ...... Total Length .� �.�........... Z'D' Box = .. Type Filter Material .k!e.._.Depth Filter Material ..../(f ........................... nc to nearest: Well .. ..�...... Foundation .../�...�......... Property Line .,S.Z_......... SEEPAGE PIT Depth ---- Diameter t ..... Number ..------_?.............. Rock Filled Yes 2--No Q t. Water Table Depth ......../ZQ.,§.._......... .......Rock Size .....�.7z.X�..... ..... . ........... FoundaTionT/ /...... Prop. Line ......Distance to nearest: Well .... .�. ... , REPAIR/ADDITION (Prev. Sanitation Permit# ............................................ L Date ........................---------- Septic .._-..-.. Se tic Tank (Specify Requirements) - - - - •-- - - ) .... ..-------------.... ...................... ..... ................................._....._.........---- Disposal Field (Specify Requirementsl ............ ... . . ---.......----.-- -- . ---------------------------------...--------- ------ --------- _------------ L ------- --- -------------------- .......................... .. -- .._.....-- .. ......-- -_.._...._........---- t (Draw existing and required addition on reverse side) �.1 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: L"I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any person in such manner asto become subject to Workman's Compensation laws of California." ` Sis ned .................. ..... - . ...... . .. . . Owner l YiaY ... .. ... . .. .. ... _�'l/ ..... .. .. . Title .... - �f..« .. of er than owner) R DEPARTMENT USE ONLY ----- —- --- - APPLICATI N ACCEPTED BY ... - -- - DATE . . . .. _ . / 7T BUILDING PERMIT ISSUED - _. :.. _. DATE ADDITIONAL COMMENT5. ._ -------------------------- 17- 1-76- .. . . __ _.. .. . - . ... �7/-76 _ Si .. _. . .