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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :1 ... . . Permit No. -10 (Complete in Triplicate) . . . ...... ....................................... ...... cc�� Dote Issued . ......... ..................................................._.... This Permit Expires 1 Year From Dale Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th;s application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulationsr JOB ADDRESS/LOC6ION ..�L.ZF'_?_.. . .....L..... ......%.a'........... .....__. ._ . ._...._.- . CENSUS TRACT .......................... Owner's Name ....K........ .JcsAta�Q:)y-d...... wSf! .................._......./....I.. . ............ ..... . ..Phone .................................... Address ._..... .yCN'. .1............. ......}...... ..:: C-. �e..(C-s....(]!.!:�...............City ..fi. -+°:.::... .............................._. Contractor's Name ....... ,-c--e�..�.:_...... ...,.`... .. -J� ......_.............License # .�. .P.. .. ..y Phone .............................. Installation will serve: Residence❑Apartment��House❑ Commercial ❑Trailer Court [] Motel C3 Other /`r•.:•. f. . Jo..G"S+r._ ".::.. ' Number of liv,,q unity . . Number of bedrooms —5.....Garbogo Grinder ............ Lot Size ::. . ........ Water Supply: Public System and name ........................ ........................-.......................................... ...............Private If Character of soil to a depth of 3 fent: Sund❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam LAS Hardpan❑ Adobe ❑ FII(Material ............If yes,type............................ (Pier plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) - PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size................................................ Liquid Depth .......................— B Capacity ...... ............. Type -.................. Material...................... No. Compartments ...................... Distance to neurest: Well ....................................Foundation ...................... Prop. line ...................... j LEACHING LINE I ] No. of Lines Length of each line............................ Total Length ............................ 'D' Box .......-... Typo Filter Material ....................Deprh Filter Material ............................................ a Distance !o nearest: Well ........................ Foundatier• rropersy Line SEEPAGE PIT [ I Depth Diameter Number ............................ Rock Filled Yes ❑ No Q7 WaterTable Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ......................f REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) C[ Septic Tank (Specify Requirements) ............. . ....................................I.............../.yam..,-,.ti..-..........._._...._._........................ Disposal Field (Specify Require ments) - -� -e"."e-. •' ��'�f'^^ "' '- - - -- ' - .........__.._. __...................... .........._. __............_....................... . . ... ........... .. ._................... ... .... .. (Draw exi sung and required addition on reverse side) I hereby certify that I have prepared this appliculion and that the work will ba done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Rogulotions of the San Joaquin Local Health District. Home owner or (kers- sed agents signature certifies the following: .. . z.rtify 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 ..... Owner _... __ ..._M-... . _ ... r li-s i.'::fc. Title . .,L-Y.t✓`<c-nra:� ...... .....__............... 8y . .. ... _. ....: ............. (if other than owner) FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY _....G .l,. ....... . . ... _. . - -- DATE .. ../ . .. .. BUILDINGPERMIT ISSUED .................._..,......................................_...................._._...._.... .....-DATE ........................................... ADDITIONAL COMMENTS ................._ ..........................................., ._.......... ............_....._........................................._............... . ....._................ ......... _._..........._........ ...,....- _.... ............ _........ ................................. .... .............. ............... .. . ........... ...... .. ............................. . . ......... Final Inspectior bY: . ............... . ..........Date ..�... .. .. .. .,,5................ ........................................... ..... r SAN JOAQUiN LOCAL HEALTH DISTRICT - 13 7/723 Y 24 E. H. 1/68 Rev. 5M