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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................. (Complete in Tri plica tel Permit No. . . This Permit Expires 1 Year From Date owed Date Issued .,(C.'/f 7Y' Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549' un a 'sfipg Rules and egulatl tr JOB ADDRESS/LOCATION •��7 -. /.Y.! �,. L� _.CENSUS YRACT ........ ................. Owner's Nome ItL.CL-(�GGci1�/rZ6Cn� N ys.. ....... ...... Phone .......................... u .Address Citya.c / s7T . . ... ......................�..../..... Contractor) Name DD ti •'(''92rLtSH d-�� c,.Z . . .License # . .. _ Phone . 6.':/�6''f•..••• Installation will serve: Residen,e gAportment House[] Commercial ❑Trailer Court Motel ❑Other . ._ ..... .......... Number of living units: Number of bedrooms ......Garbage Grinder lot Size .._l �.�'C:a'...:..............'� Water Supply: Public System and name . . . .. .......... ._... ................. .. ......._............... ....PHvate '(� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ 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 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 ... .. ... Capacity Type Material. No. Compartments .. . _. .. . . Distance to nearest: Well - _._... ._. .Foundation __ Prop. Line ..... LEACHING LINE ( ] No. of Lines Length of each line Total Length .. ...........I...... 'DBox T,,pe Filter Material . .._.. ._...Depth Filter Material _. ..._......................... Distance to nearest; Well Foundation Property line . .. SEEPAGE PIT ( ( Depth Diameter _.. __..__ Numbe• _. Rock Filled Yes No ❑ Water Table Depth ._ _..........................Rock Size _. ...__.._.. .... Distance to nearest: Wei: . ........ .....Foundation . .. Prop. Line .... ................. REPAIR/ADDITION(Prev. Sanitation Permit# . Date .__ _. .._..._. . ......._..) Septic Tank (Specify Requirements) -F— KL T'R AL .. .... .. .... ... .. ._ . .... ... ........... Disposal Field (Specify Recuirements) b-F� "^ •- ..�a' �7fy�r c (Draw existing and n+qulred addition on &verse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, Stale Laws, and Rules and Regulations of the San Joaquin Lecal Health District. Home owner or Ilcen- sed agents signature certifies the following: "1 certify shot In th penrformance of the work for which this permit is issued, I shall not employ any person in such manner as to bat/pme sub' t to Workmas Compensation laws of California.'• Signed N�r CTti�tt�1 [- J/x-• --^('� /.L. ... .(<'arner- By / �i.[�cl-`2. , ,Title `�0 ,•_ (if other than owner) Y / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,,{4/�l„/ jSti.�, �a..-� DATE BUILDING PERMIT ISSUED / _ _ / DATE ADDITIONAL COMMENTS i Final inspection by: ��- �T SAN JOAQUIN LOCAL HEALTH DISTRICT Date E. H. 13 241•'58 Rev. 5M 7/723 ,4