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FOR OFFICE USE: �, APPLICyATION FOR SANITATION P -------- - - No � a ` T (Complete in Triplicate) �._.N' 4 ' ------------ This Permit kpires 1 Year From Date Issued Date Issued L. Application is hereby made to the San Joaquin Locallealth District for a permit to construct and install the work herein described. This application is made in compliance vJI. County Ordinance No. 549 and existing Rules and Regulations: L JOB ADDRESS/LOCATI N .1- -�5®y�_. -<_.__ �t'r _.t�2 _�_...._.__CENSUS TRACT ..._.._-__..._._.-._. Owner's Name -. ter. t- ------------------- ------- ---------- --- - /1 ..nPhone.. - - Address ? CLt- --- -- --- - City -7.-Irr��. 1,-,)--------- ----------------------------- 6. Contractor's Name .._.__ -___ _. -- __.. g,License ##134?-?`� Phone ._..__.._.._. ............. r Installation will serve: Residence Apartment House❑ Commercial []Trailer Court [] L - Motel ❑Other ..... ----------........... ..- Number of livingunits:'_.__. ...._ Number of bedrooms �yy 4w „ �S-_._.-Garbage Grinder..___._ Lot Size __________.�-�—.�........__ Water Supply: Public System and nameJ-------- --------------------_-----------------------------_ ...._......_.._- .--.-. ------Private [!�� Ir. Character of soil to a depth of 3 feet: • Sand E] Slit C] Clay E] Peat E] ----.--Sandy Loam Clay Lam l] i Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type --------------------------- (Plot ..___.____'.__-_._(Plot plan, showing seize of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) \ NEW INSTALLATION:: (No septic..tank or seep a pit permittedIfublic sewer is available within 200 feet,) r. 01 PACKAGE TREATMfIT [] SEPTIC TANK bize.7 i _g t _: Liquid De�ih ---------_. Capacity l .Q. Type _ Material@�- No. Comport rryents ..4 . , o �t� ,Distance to neare Well . j._0 __..____Foundation /.f1.___.____ Prop Line . . _ . LEACHING LANE ! [ o. of Lines ..... Length of-egch line..... ..------- Total Length _. N `- 'D' Box hype FilteryMgterial .._ __Depth Filter Material ._._f_ __ . Distance t nearest: Well ...:_ � -_ _ Foundation _.�.f? �__-.__ Property Line ...------....... l`t SEEPAGE PIT, [ ] Depth .-_. ---------- Diameter -_ ____-` NumberRock Filled Yes ❑ No C]--------------------------- j ! Water Table Depfh ------------------ -1-------------------------Rock Size ------------------------------- I Distance to nearest: Well --- --------- .__.____.._..___..____Foundation _____._..________.. Prop.;� Line ---------------------- REPAIR/ADDITION(Prev. ___.___.__.__...__REPAIR/ADDITION(Prev. Sanitation Permit# - ,-Date L Septic Tank (Specify Requirements) ____ + ------------------ Disposal Field (Specify Requirements) --------- --- ----------------------------- -------------------------------- r. - ------------------------------------------------------------------------------------------- ----- -- ----------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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. Homo owner or licen- sed agents signature certifies the following: i "I certify that in the performance of the work for which this permit is issued, I shall not employ any peelon in such manner as to beco u ject to Workman' ensation laws of California." Signed - -- - -------------- - - - -- Owner - 8y --- - ✓' - - - . Title _ -- 61W (If other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - f - -`' -- - DATE . = ------- ------- t.' BUILDING PERMIT ISSUED - ----- -------- -- -------------------------- ADDITIONAL COMMENTS -- - ---------- - ------------------- ------ --- - - - -- - ---- - ----------- -------- -------- - - - - -- - - - - o -- _ - - --------------- -- -- - - - - - Final Inspection by: - L SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'B8 Rev. 5M