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FOR OFFICE USE: '.PPLICATION FOR SANITATION PE IT _... w ./ (Complete in Triplicate) Permit No. ..7.V.- 3�.7 ._..__... This Permit Expires 1 Year From Date Issued 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 aRpca ti madejn cl�rith��junty Ordinance No. 5 9 a�>nd exis 'n�ges and Regulations: JOB ADDRESS/ TION/, . .7n"c-.LTJ �4_. _._ 4� ...-1L3.....�H. frv1....CENSUS TRACT .............. Owner's Na -.�-.._ - -------- -------- -_...--'---------- / ..--...- ........------ Address _..�...5'.Z� . .-../C... - (/t2�-�. �� .. .� • City -----"' .,1..�.�-`•��'s Contractor's Name .-_-_ .Lo QJ)�}F.['�. r`/C--- ------ft.: License # ID73 K Phone .............................. Installation will serve: Residence ❑ Apartment H use❑ Commercial ❑Trailer Court ❑ Motel ❑Other ....... .-._-------.-.-.-- Number of living units:.._. Number of bedrooms --.._—::.Garbage Grinder ..... Lot Size .-_e r-- Fri-/...---� Water Supply: Public System and name -------- ------------------------------- ..............................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 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 -.�................... i �y� Capacity - Oo_.. .Q Type ra. Material-l`a. Compartments ........ ..-� �,(/ Distance to neatest: Well ..-_----_5G{'�//�- Foundation Ailter _.GL - Prop. Line --J�... .......... LEACHING LINE [Yl No. of Lines ..._ ------------ Length of each line...... Total Length D' Box Type Filler Material ... 5- .-.-.Depth terial ._- - ..��................. .. '�/ Distance to �e�r Well ..._ C� }. Foundation ...-_loa�-- Property Line --...- SEEPAGE PIT I i[ Depth _ ,� Diameter -_�-.-...-.. Number ...-_.1...... ..... .... Rock Filled Yes No Q Water Table Depth .---.......�Q. Rock Size --1 �2.... ......... Distance to nearest: Well --------------�Q� .....Foundation .._/ 41 Prop. Line ..... ..--..-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ..................................I SepticTank (Specify Requirements) ----------------..................................................................._------------...---------_ ................... ...... Disposal Field (Specify Requirements) _._._..... __ .----_.._..__........__._ ----------------------------------------------- -...................................--.........__..._................ ....._..--._...--. (Draw existing and required addition 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 licen. 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 subject to War a 's Compens laws of California." Signed .__.._.................... - --t. ... ...- Owner BY . r - --- "- �C -- -• Title ..SL'.L Vltatr ....... ............................ . . . - . . . . (if other than owner) FOR DEPARTMENT USE ONLY _ 7 APPLICATION ACCEPTED BY -- x::J.2:4: i......... . ....- . .............................. DATE .:...--L�..:- - ' ----------------- BUILDINGPERMIT ISSUED ----- ----------------------------- -------------------------- --------- .....................DATE ........................................... ADDITIONALCOMMENTS _.._................................................... ..... ..... -- . . _..........---------...--------------------................... - ....-................... ------- -- rt-- -------------------------------------------------..--------------------------------------- -- - - ------- --......----------- ------ --------. f ................ -Final ection bY - -- -- .... ---- .. -- ..-......... - - - - Date - - - - ......- SAN JOAQUIN LOCAL HEALTH DISTRICTly� E. H. 13 24 1-'AA a..,, SM