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AMCATION FOR SANITATION PERMIT Permit No. 26: S 5:L _...................................................... (Complete In Triplicate) ........................................................ Date Issued .��............ This Permit Expires 1 Year From Date Issued AppUeaflon 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 compilance with County Ordinance No. Soy and existing Rules and Regulations: r .... CENSUS TRACT ... JOB ADDRESS/LOCAT�jL. .. �..�. � ....................... Owner's Name X11.-.Q ../LenceEMpartment C.rt�L r..... one .................................... Address .....8�S4... ..,, ..................._city --�� .............. ��JContractor's Name ... ....� __...... _..License # �� :. �.... Phone .e-Installation will servo (/ R sHouse(I Commercial QTroller Court Q Motel ❑Other ------------_----------- ---------•---- Number of living units:__........ Number of bedrooms _V. ....Garbage Grinder ............ lot Sin --•-----•--•-••-•................................... Water Supply: Public System and name ..........................__.-....-................... �......._._.._ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay foam ❑ 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 an reverse side.IQ NEW INSTALLATIONS INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK( 1 Size-.......................................... ... Liquid Depth .......................... ,y� 9 . ateriai........... .......... fJ Compartments Capacity .�d� ......... Type . ,,ryry/� . Foundation . +_p............. Pro Lltts ..._....�.._»_ Distance to nearest: Well ..1.UG...p----------------•--- • 1p' LEACHING LINE ( 1 No. of Lines �. . ----- ---- Length of each line....r/-�................ Total Lengt ..�� -•----•••-• ...De ...................�.... 'D° Box _�_...... Type Filter Material . ... _. - Depth Filter Material _�...r •...................... Pro Line ...................».. Distance to nearest: Well ........................ Foundation Property SEEPAGE PIT ( J Depth Diameter Number ............................ Rock Filled Yes ❑ Pio ❑ WaterTable Depth .... ................__..................Rock Size ................................ Distance to neorest: Well _-----------------_-------------------Foundation .................... Prop. Line ......... REPAIR/ADDITION(Prov. Sanitation Parmlt# ---------••-•••-•••--•-••---•---••••••••••- Date -------------------_..----------1 Septic Tank ISpecify Requiremonis) •..................•.............................--..............................._................... »».... Disposal Field (Specify Requirements) ........................................................................................................ .............. _ .......-......................._. .-----•---........._...................................................... . _........_...._.._.. . - - ............... ......................................................_.............................................................................._............ (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. Home owner or "can- ted agents signature certifies the following: "I 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 su lett to W rkman's Co ensation laws of California." P //✓ IC Owner Signed .�C ..a-..... ................. ............................ •- ,r. By _.. Title _.. ..._-.._..._..._. -. (If other than owner) FOR DEPARTM)ILNT USE ONLY APPLICATION ACCEPTED BY .... .................... ................................ DATE . '.... BUILDING PERMIT ISSUED ....................................................-.... -•-•- ..........._._... MATE .. . ... ............... ADDITIONALCOMMENTS ................. . ............................................-- ........_,.................._.................... ....................... ........ ........_.....--. .....................................................• ..............• ..---... ..................................... Final Inspection by: .... .. . ----• .... Doh .. --.._ ... .............. EH 13 2!s 1-68 Nov. yH SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M