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FOR OFFICE USE: Sf.S`: APPLICATION FOR SANITATION PERMIT (Complete In Tri Permit No. ._...-].)-..... 6 _-_.__._..--_.............._.. ...-._........... This Permit Expires tYear From Date Issued Date Issued2 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereir described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION 439 ,L_ . � __. - ...- t,f.l..:�.�.. -..-. ._ ... .-CENSUS TRACT Owner's Name .. O- �. - ----- Ls .N-------1:3-PzQ- -� ali.4'�'EL -_.-- --------- -----Phone ........ --_...-......... / I e , Address _ -33.6---------- =-- ---L.-�G. _S------I.....----.......City ..._.I194PDA)........ ........................................ Contractor's Name .. DLV/1J. .............License # ....._.... ....... ---- Phone .............................. instai!ation will serve: Residenpartment House Commercial ❑Trailer Court ❑ Motel ❑ her . - .............................. Number, of living units: -. .... Number of bedroom s_1 ------Garbage Grinder ..._- ..... Lot Size ACRF_A6E.. Water Supp!y: Public System and name _ ----.----- - . ._ - ___...Prlvatq�< ♦ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom At" Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materioi �.. if yes, type (Plot pian,, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW WSTA"TION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ) 1 SEPTIC TANK Size-- ----...-. Liquid Depth ...... .- �/ �p-�.^ 1;Vi s.-.X_..�.._: lf'..._... Capacity 4200...-- Type j�')«`7i. Materials f/NsK_r- No. Compartments .._................ Distance to nearest: Well ..._...�-----17........Foundation .1Q.. ?".._-- Prop. Line ------ .._5- LEACHING LINE No, of Lines — ......... ..... Length Oleach line.-._ -0 . Total Length ....... 'D' 'D' Box Type Filter Material -_ _n -Depth Filter Material .....� /0 Distance to nearest: Well ..SU-. "T-.- Foundation - -��_'i---- Property Line - SEEPAGE PIT ( ] Depth .....-_. ....... --- Diameter -- ------------- Number --------------------- Rock Filled Yes C] No ❑ Wdter Table Depth - ......_...... ...... ............Rock Size Distance to nearest: Well .. ..........-.... .....................Foundation .................... Prop. Line ..................... REPAIR/ADDITIONiPrev. Sanitation Permit# ---------------------------------- ---_---. Date -............................... Septic Tank-(Specify Requirements) ........................... ............... --------------------....-_...-- Disposal =ieid (Specify Requirements) _.. ... . --- .. _...--........ .................................................. ----------,._.._.._ ......... - -...._....-------- --- --- ----- ------------ ...... . -- ♦ (Draw existing and required addition on reverse side) i hereby ;emits 'no! ha-e orepared this application and that the work will be dome In accordance with San Joaquin County Ordinances "sate '.aws. and Rules and Regulations of rine Ser. Joaquin Local Health District. Home owner or licen- sed agents signature terrifies 'he -oliowinge "I certify that In rhe Performance of the work ror which this permit is issued, I shall not employ any person in such manner as to become sub)ect . Workmar`. Compensation taws of Callfamla." Signed .n- ., rl�. . >- .it - --... ------------_------- Owner BY - _./�:fY..---i _C - Title -._. other than owner) ------- ---- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE .. BUILDING PERMIT ISSUED . _-- . _.._.DATE ADDITIONAL COMMENTS _..-. . - Final Inspectio .. -... i!� '�-e'"- .Date +rte i �`�+I -- _.. SAN JOAQUIN LOCAL HEALTH DISTRICT r F 9 1-'(.R Rnv 5M