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FOR OFFICE USE: '1PPLICATION FOR SANITATION PEP 'T _ �.+ (Complete in Triplicate) Permit No. 1�1J._� _V This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health�Dis rict for a permit to construct and install the work herein described. This application is made in com liance with Cou ty rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._I- -g�1 D_. l-H.I�U .____ l--1 61T�._-__.__CENSUS TRACT __.! _________________ Owner's Name -----------�lL{# 1' _t--=..__ _ THBFF� --- ---------Phone ----- 0 Address - � - fl�L ♦♦♦ ------ ------ ------------------ City l�l_` fl- �. ------------------------------- Contractor's Name __©HI/v 7�------- ---- -•-•-•---- -- -- --- -.License # -----------------------. Phone .............................. Installation will serve: Res idence??-i4parfinent House❑ Commercial ❑Trailer Court '❑ Motel Other - -------------------------- �/ Number of living units:_-_-/ .._ Number of bedrois � �Garbage Grinder -------- --- Lot Size__.(a--00vR D -------------- Water Supply: Public System and name ------------- f --------------------------- --------------------_-------------------------------------Private Character of soil to a depth of 3 feet: San SiltClay ❑ Peat❑ Sandy loam -] Clay Loam ❑- wF - - 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 swer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC /TANK'[+] Size._-S.._.__y�x�-v-_.-.-..__:-- Liquid Depth Capacity _16.0.0---- Type PRI F�-B_ Materia1__4fCNGK_It No. Comp¢rtments Z Distance to nearest: Well _ ______ ____ ________ "___.Foundation -------------A,0__ Drop. Line ------- 45t LEACHING LINE No. of Lines -..._:.�-__ -- Length of each line ------------JTJ, Length ____s.__Qo. _._.__ YP _ - P L J Tot 'D' Box yE._ type Filter Material RD.LK..._De Depth Fllter aterial 1.,�9%_.{____-------�..---.- e _ - --- -- ,._ - PTop Filed l� v-------------------._ I Distanc o nea st: Well �5___ _ Foundation if �f ------ - - R42k i led -_ SEEPAGE PIT [ ] Depth ______________ _____ Didmeter Number � fit! ❑ o I(] Water Table Depth Rock Size __-__4-------------------- Distance __; ! !' Distance to nearest: Well ________________________________________Foundation __- ----------- ---- Prop. Lin __-__ :;,______- REPAIR/ADDITION(Prev. Sanitation Permit# _____._-_--_-___________________------ Date -------- ------�______ _-___.-.--) I \' n Septic Tank (Specify Requirements) - --------------- t = vJ ---------------------------------------------------------- --- -----°----------- ----- Disposal Field (Specify Requirements) --- -----------------•------------------------------------------ ( L # j---------- --------- ---------- - -- ----------------- - - - ---------- - ------------ - --------------------4-1------:----------=-----�--------•-'-- = 1_ - (Draw existing anrequired'(gddition on reveVse side) I I hereby certify that I have prepared this application and that the '�"�ork will be done in accordance wit San Joaquin County Ordinances, State Laws, and Rules and Regulations of t}ie'SIX Joaquin Local Health District. Home Pwner or licen- sed agents signature certifies the following: ` "I certify that in the performance of the work for which this permit is issu , ! shall not employ any per in such manner as to become subject to Workman's Compensation laws of California.' �p,j` SigneCl•_.,.1 ------------ -- ------- --- -------------- ---------- Owner BY ----- --- - / - ----.- Title - -- ----------------•--------------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY7__(_R__._�--_______._ ------------------------------------------------------- DATE ----- S' ------------ BUILDINGPERMIT ISSUED --------------- , •-----------------------------------------------------•---------------•------•-------------DATE ----- ------------------------------------- *DITIONAL COMMENTS __________ -------------- ------------ - -------------------------------------------•-----------------------------------------------• - ------------ ---------------------- ---- -------------------•-------•----------------------------------•----------------------•----•-•------------ -,--------------jj---_ .:_ --- - Final Inspection�/ ----- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M