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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITy �2/ ................................. . (Complete in Triplicate) Permit No. e/ ......... . ............... This Permit Expires 1 Year From Date Issued Date issued._'t.'e �a Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This avalication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOION ..�f...L//.......C�'.....---.c�dl� ll.-1f��J4-- CETRACTp V�J. a Owner's Name ...IC~�l-�/ -- �E?LZ��/L'1.1 ..T... } .................. Phone d .�'j�� Address .. . '.. ...{... 'i..... 1 21: V................City / Contractor's Blame .......�.... �Ca.��Lr:.�»�................License #`'7`-'�C��9.... Phone .�.f3i�:L�LS� Installation will serve: Residence CZ Apar _ent House[] Commercial ❑Trailer Court 0 Motel ❑Other.................................... .... " fC!�2.P .._P Number of living units: ........... Number of bedrooms 1.�......Garbage Grinder ............ Lot Size .. . �..-�.............. 1 I tt Water Supply: Public System and name ........... ..... .•---........ ................. .............. Privatelo 1 � Character of soil to a depth of 3 feet: Sand Silt Q Clay ❑ Peat❑ Scndy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ } SEPTIC TANK[ ] Size_....................... ...... ... .... Liquid Depth ................_........ N Capacity ..... ........ ..... Type Pate~;al..................... No. Compartments ...................... Distance to nearest: Well . . ...................... .........Foundations...................... Prop. Line........... LEACHING LINE No, of Lines ......... Length of r.ach line .. ...�� .... Total Len th ..-.../....Gr ....... I1 9 L. ..........- g .D �+ • D' Box ............ Type Filter Materia! .-r.�.L?Lrr ..Depth Filter Material ....17.................... _ ........... r � r Distance to nearest: Well ... .. .. ....... Foundation ......L ............. Property line .... ................. SEEPAGE PIT [ ] Depth ..... . ........... Diameter ................ Number .....................--..... Rock Filled Yes 0 No Q WaterTable Depth ................................................Rock Size ................. .............. Distance to nearest: Well ........................................Foundation ........--.......... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .........--.....................--1 Septic Tank (Specify Requirements) ...... .. .. ... ,..�....-.... ............................-....................................................... I'dDisposal ,Field {Specify Requirements) /y •••••• ...�7 t�z/.`!jtvt ................. .. _.......... ....... .............--.. .................. ....... ............--................. (Draw existing and required addition an reverse side) i 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Jaaquirn County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home Owner or 11cen. sed agents signature certifies the following: "1 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." ��: Signed ........................ it ��....-_ . ................... .. Owner �� C ' Title .............. ......... ..----. ay .. ... ..- ._ . .. . _�. .. -- —llf of er than oti-nevi FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .- *f ................... ... .......... ..........., DATE . ..-.. ...-6Z BUILDING PERMIT ISSUED . ............ ... ... . ..... ......... ........... ..............DATE ........ ADDITIONALCOMMENTS ... ........... . ... .. ... ....... .. . -- ... ..................... - .-- ...-----........................... ............. .. .. . ... . - .. ....,. . .. ........ .. Final In"spectromby—mo i%< � .. .. .. ;. .SLV.....S..... ....... . ... ..Date ..r.. ... SAN JOAQUIN LOC-AL HEALTH DISTRICT E. H. 9 1•'68 Rev, 5M y i