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rVK V rICE USE: ,. APPLICATION FOR SANITATION PEPMIT �.� ............J-i-°-k5a-- Permit No7�,. s.... (Complete In Triplicate) - ..... i ....... ........................ .............. 7 -------_----- This Permit Expires T Year From Date Issued Date Issued ../....:1:_0 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 withCountyOrdinance No. 549 andel existing Rules and Regulations: JOB ADDRESS/LOCATION ..a...t ....__.7--.'flJ... ...� --�.. .. .. .. ee...1.."KCENSUS TRACT ........ ................. Owner's Name /- Q�,.l - ...Phone .......................... --��1..y. ......p.. .. yy�. 1..�. .�..../.. .... ��, �r� Address _.a4-off . �a�--yL.. ....F. . /�/-.1..L liJ/W...City ..Rf .�!. �f.../.. <!�-..---- �y//7��y�/,�, / Contractor's Name .- _--...K-..0 .lL.......... - 11.. ........... .................License ill r L../)V_r.3' Phone ..... /�- Installation will serve: Residence partment House[] Commercial❑Trailer Court ❑ Motel ❑Other............ . �.' Number of living units:_ . ... Number of bedrooms ..... ....Garbage Grinder . .... Lot Size .................. Water Supply: Public System and name ...................... ---•..•,.•...•....--•• Private flY - ...........__....................�. ..._.......................................... J° Character of soil to a depth of 3 feet: Sand❑ Silt❑ ClayPeat❑ Sandy Loam ❑ Clay Loam ❑ _ Hardpan ❑ Adobe Fill Material . fo. 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 seyver its available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size....'X.../ ��j /.�.�........... Liquid Depth .X?................ Ca oci � ` v p ty � ...._.... Typo .. ..�,L�G7.��?�Caterial .. @7-�iL.�" No. Compartments ..ori._._..... Die nee to nearest: Wall .....-.c7"..... . foundation .. ...Q............. Pro Line ..��......... . •......... . 77 P• LEACHING LINE [ No. of Length of each line... 5/0.x.----------_ Tota[ Length .��Z........... _ 'D' Box - .. Type Filter Matt�er-rrr�i-/a�1l �0......Depth Filter Material ..../(..1............................ N nc to nearest: Well ../r ..�...... Foundation .../�...�......... Property Line .. ... 2.......... SEEPAGE PIT De ih _ aZ� ..... Diameter ��...�./... . Number ..... ............. Rack• Filled Yes 0-1,46-0 Water Table Depth _-----./Q,� ......-. .................Rock Size --•-- -----. Distance to nearest: Well ...... .................Foundation 1_0_!...... Prop. Line ..Z_2........ _ REPAIR/ADDITION(Prev. Sanitation Permit# .........-_......._...._................. Date .................................. ) SepticTank ISpecify Requirements) ...................................... ............................. ...........................-.........._................. Disposal Field (Specify Requirements) .......... .......................... ------ --------- -- - -- . - - . ............ .. .. ... ... .......... ----•-------- . --- ----. .. _ -. ---- . .... -..-_ _.. ..._.. ----... ` ............... ...............-.... . . . (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: - "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 Workman's Compensation laws of California." Signed . . . - _. -. ..... _... .... Owner . . >rT ca Title . . _ _. . of er than owner► R DEPARTMENT USE ONLY APPLICATI N ACCEPTED BY ._ . ._... . .. DATE 11 4... .. .. . .. . BUILDING PERMIT ISSUED ..... . . _.. . .( _... -.........._ - - - ----.................DATE . _ ADDITIONAL COMM NTs� . .. - . . . ... --. ........................ .. .- -- ....._....._... _......... Final Inspection by. -. . .. ..Date EH 13 24 1-68 1 AN J A`IIN LOCAL HEALTH DISTRICT 8/7h 3M