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k FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---............... ................. Permit No: (Complete in Triplicate) ••---� - ••••••-� ........................................................ . ............................. This Permit Expires 1 Year From DohIssued Date Issued a Application is.hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin described. This application ismade,in compliance with County Ordinance No. 549 and existing Rules and Regulations; r J08 ADDRESS/Lp/�pTION t..L7.Z^ )Q.-S.. � S.L.vari...-:------••(71\-ir-..-._..;_...CENSUS T CT �../V�-':��pl_-.- Owner's Nome K--a .W.....r....G-1�l.R. . .... ...............- ..................................Phone R Address ._/��.�QQ......Jt.�..�4G /..iT�... -........City -..IL T- -v.}p'._.------............pp.._s�_�....... ........... + Contractor's Name ---- ..._�/Q. 'ILP......-__._-..............:........License zwor dr' Phone .4 � Installation will serve: Residence lid Apartment House 0 Commercial OTroiler Court ✓ 1 Motel ❑Other........................................... Number of living units:....(.__.... Number of bedrooms..'3.....Garbcgi,Grinder ............ Lot Size ......--.-....._- Water Supply: Public System and name. ............_._......._.._......._.._----..................-.-. .-._............_..........-_.._.Privatel$ Character of soil to a depth of 3 feet Sand 5' Silt O Clay .❑ Peat❑ Sandy Loam ❑ . Clay Loam❑ ; (Hardpan ❑ Adobe i] Fi11 Materiel ......J.�. If yea,type _. .............:...'..... (Plot plan, showing size of lot, location of system in relation tor wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeps pit permitted if public sewer is available within 200 feet,) 111 PACKAGE TREATMENT [ ] SEPTIC TANK.1#0- Size._.-..._..-- � Li uid De L.67A ............ Capacity 2.60.0....... Type. Material--- - !- a. Compartments r Lance to nearest: Well .............................Foundation -.t d..�......... Prop. Line LS-.0............. LEACHING LINE [ No. of Lines . ................. Length o--f--•��each``Iine. Q.-....._........ Total LengN ----------__._.....� J 'D' Box Z....... Type Filter Material ffr.6..l�. th Filter Material ..AV. .......... O 1 yP r ----.Dep , .. .. ��--•---•--•--- O Distance to nearest: Well -...e. .......... Foundation /....Q................ Property Line. ._...._.._.._..._... SEEPAGE PIT [ ] Depth ..................... Diameter ................ Number ...................._...... Rock Filled Yes p No ❑ N }� Water Table Depth ...............................?..............Rock Size ................................ Distance tolnearest: Well .T...................................................................Foundation .............. Prop. Line .........___._..__(� REPAIR/ADDITION(Prev. Sanitation lPermit r#................................ ........... Date ................................ ) M I Septic Tank (Specify Requirements) ....:....:---..:.....--•----------------t...----------.....--------------..._..^..................------^.......................... Disposal Field (Specify Requirements) ........... ••...................... ............... ............................................_. .......................................--.................•...........................................-•........_..............._._...........:_..-. r i ...:::........_....................................... -................- ..:......_........_............_....... ) ...._._.. (Draw existing and required addition on reverse side " ._ - —T -^----� -..d 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: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." - Signed . . ... .. . . ............ ..........._. .... Owner By---- ---- ......�-F?.. ........ ..... Title --.................................'- -� . ...... :..............-...... ' ----............-.....:...,.... (if other than owsifr}t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...T. r -_....--------................-----.....-------••-------....... ------- DATE .....!.?, - -7 ........... BUILDING PERMIT ISSUED...:....:.... DATE ....-.----.......-.........-. ..... ..........----...... ..........._................---.-...._ ADDITIONAL COMMENTS......... .. ....... ..... _ ._... .._.. -------------------------- ............ .----...._---.._.....,.........._.._............ - - - - ............................................................... _..... _. Final Inspection , .. � - � �•• -�-• -- ._. ---- ------- - -----------. ....................................Date.... -------. . SAN JOAQUIN LOCAL HEALTH DISTRICT 4 ' E..H. 9 1•'68 Rev.5M