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LAPPLICATION FOR SANITATION PERMIT ......_..... .... ............................. S (Complete In Triplicate) Permit .... .. q ........................ ... .... ... . This Permit Expires 1 Year From Date Issued Date Issued ./...- 1-.:. G Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Ldescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA/T }1 . . ................................CENSUS TRACT ......... ................. . ..., Owner's Nameta• ..................................I. ............ .�. .....Phone _ _ ...................... I` Address S 'Z .. 7.�tZt.tRr/-r? .. .......... �---...._...City ..%/..<<..h.'....L.� ... . ... ._ .__......... --- Y �r Contractor's Name ... �124::>1.../..�,�r�2:->.1L=it.�.............. ..!..;.,.....License # I..tYtX.:-M.Z.... Phone .............................. Installation will serve- Residence Q Apartment Houseo Commercial ❑Trailer Court ❑ r Motel ❑ Other ........................................... Number of living units:.......... Number of bedrooms .....• ...Garbage Grinder ............ Lot Size .... wL! L"�._..----------- .. . - 3-- r Water Supply: Public System and name .................................. - _....................------....._.... . ..................................Private W Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ O r Hardpan mfl� 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,) r PACKAGE TREATMENT [ ) SEPTI TANK[If Siza.J�rfit:1C�5-:��`.�N..... Liquid Depth ... ...... Capacity ....�C.C..C....... Type Material....44.lzc_-. No. Compartments .._:Z:......_... /r Distance to nearest: Well ...........tom$:. ...............Foundation ....../...4'.�:... Prop. Line .__ . LEACHING LINE [l� No. of Lines y ......J............. Length of each Iine. :a'�.�1........ Total Length ..: � �_.._. 'D' Box ../........ Type Filter Material ..._S&......Depth Filter Material ...../... / Distance to nearest: Well .......SR ..... Foundation .....lClj'........ Property Line .. 5✓....._.... SEEPAGE PIT [,] Depth ... �i1�rf.... Diameter ... i.. Number ........... 2 ............ Rock Filled Yes No Water Table Depth ---------------------------Rock Size ..L..�7...�C-_3_........ Distance to nearest: Well .......1.Q.G:.�________________Foundation ...LO.. .... Prop. Line ...... REPAIR/ADDITION(Prev. Sanitation Permit# .................. ......................... Date ..................__.._........... ) e. SepticTank (Specify Requirements) .................................................................................._......................-...-......._--------------- Disposai Field (Specify Requirements) ............................................-................................-...................................................... . .---.. -........................... --- .........-----.--------.....------................................ ......................... --------------------..................._......_.. .................... . ..... ....-.- .............. ......-.-- --- . ..........................---............................................... ------.................... ... ....... (Draw existing and required addition on reverse side) L, 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 liter- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...._................ Owner LBY ... .... 4i- ,-,. /� ..G =7. �Ff�(r............. Title (If other than owner) �_ — FOR DEP RTMENT USE ONLY pp _. APPLICATION ACCEPTED BY .__. `.c_.. . ..:..... ........ .V ................... DATE BUILDING PERMIT ISSUED .._.. _.............------------------ .. ................._.. ................... ..............DATE LV ADDITIONAL COMMENTS ......_.. ....... ..................... _. . _:........................... {L• ... ......... .. / final Inspection by: ..----....�j... . ...................................... .........__............................Gate .tf.�f.. r�.....---.........----.- L EH 13 2L 1-68 Rev. 5}f SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h. 3.M