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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete 1n Triplicate) Permit No. ..,7r�.� Y •//1 Date Issued ,......_._.,/....... This Pennff Expires Year From Date Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCATION Va)-win' --, CENSUS TRACT _-5-`I-7.....---.--•-- Owner's Name ...-.0-M...... /--------- -.. ... —_ _.....Phon e .. ......_-- ....... ......— Address 2.3-70.1. ...Er--.�JcO'7.►cST_l'{G�.._..._.....__..,._. City .... rQ. .�'.-.__......_f��.._......_. Contractor's Noma -(iLL .tT.0--.--( CGfl. .GL7_.....-_'____._..__-License # -aA.C1J2 Phaele .-,3 A_-tn2_CrQ Installation will serve: Residence®-ikrortment Housso Commercial ❑Trailer Court Q Motel ❑Other .......... Number ........_.._.._.`............_............. . Number of living units: _ /----- Number of bedrooms -.3---.Garbage Grinder Lot Size _._................................. Water Supply: Public System and name ---------__.__-_.,,-......_. .... � ------.�._.._._._._..__—P1'ivale� Character of soil to a depth of 3 feet: Sand 0 Slit-0 Clay eat Sandy Loam ❑ Clay Lam 0 Hardpan gg.Adobe ❑ Fill Material -..__ _. If yes, type __..r-- ._..._.......... �- (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc. must be placed on reverse side-) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ I SEPTIC.FANK{1 �7 -� Size _120ff i q p � t� Capacity t200.gt Type FbCr fascMaterial_.._...._..,_..,._. No. Compartments _-.15600 --.�»_.._...__. t t Distance to nearest: Well -.. Q..—....__.___Foundation...i✓.Q__..---- Prop. une__A s�—. c LEACHING LINE [ ) No. of lines ..3----- LMgth of ee�dl lina.�._�j[L-Q...... .......... Total Lenplh ...�-�...�Q._—__ t 'D' Box ...-/...... Type Filter' . . Malerial ] ../'Iepth 1`04r Material -----IAV.-#L ..........-----------.__—__ Distance to nearest: Well .----. �Q.�...:: Foundation- .1e�: Property Line -.2.Q......_... SEEPAGE PIT Number ....-.eRock Filled Yes n --hid, 13 7N Water Table Depth ...............2.QQ._...._.........Rock Size.__..Lr------.__.,_-_ 4 /� Distance to nearest: Well _..- _uQt —. __ _.. ._ ...._Foundation .., .Q------- Prop. LGN ._...._ REPAIR/ADDITION IPrev. Sanitation Permit tili............................-----------..... Date __-_-------__-----.— ) SepticTank (Specify Requirements) --------------—__-__-__......_-_...................._......_..__.—..._..__._.-___..._.._.._..__._.....—_.............. Disposal Field (Specify Requirements) --_.......................................................................... i_........ --------------------------------------- -_---- ---------- (Draw existing"and required addttlon on reverse side) I hereby certify that I 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 Ilcen- sed 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 subiect to Workman's Compensation laws of California." Signed _.__-------------------'....................... ---------------'----- Owner B .........._._.... title eO'7_____.. y .._.-. ,,,�. .. other than owner) R/ _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. - --- -_--- -._-----__—.__..._-._ . -------___.............. DATE 3.-.._ ... BUILDING PERMIT ISSUED ------ ---- --------------------------_.__......—_.._......-_----------_----- ----DATE ---......... ----................ ADDITIONAL CO hWENTS........- ... l' . ........................._.-__._. ._.. s.:.... __ .. .- ._ _ aw final Inapedion by: . ---------------------------------------•-•_ SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1•'68 Rev. 5M