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FOR CIFFICE USE: APPLICATION FOR SANITATION PERMIT ...................... ...................... ..... Permit No. / (Complete in Triplicate) .......................................................... ......................... .............................. This Permit Expires 1 Year From Date Issued .. Date Issued1a?.: ?y Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein d,-scribed. This application iss�made in compliance with County Ordinance No. 549 and existing Rules and Regulations! JOB ADDRESS/LOCATION !.�D17._-.��.......STi..E.L N.t��.LI� ..CENSUS TRACT -J-`.��---.... Owner's Name .....LJ. . ..........� L.WAN..... Phone Address .........N917..-.5..-.----:5 -]FI AF_GVi—................City ..0A.K-D.A..4.�------------------------------------------ !. ..... .7�.G.... Contractor's Name ......CO.!..............License# .-.--.........-..--...-- Phone$�7--. 1 Installation will serve: Residence®Apartment House❑ Commercial ❑Trailer Court n Motel ❑Other. .. . . ................................ Number of living units:...../.... Number of bedrooms .......Garbage Grinder>1F5. Lot Size -.-A(-.REAfiE............ Water Supply: Public System and name ..............................................................................................................Private ®� Character of soil to a depth of 3 feet: Sand L Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Lir HordponEr--Adobe Q Fill Material .. . If yes,type......... .............. � -— - —_-_ - .,_.gym •-- � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTAL(ATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' PACKAGE TREATMENT r] SEPTIC TANK[ ] Size..... .................. Liquid Depth .....--..... v , Capacity _ _.... . ...... Type .................... aterial...... ..... ......... No. Compartments ...................... Distance to nearest: Well ............._...-.. .............Foundation .. -.................. Prop. Line...................... LEACHING LIME [ J No. of Lines __.. ._ -. .. Length of pch line- Totul Length ............................ 'D' Box ...... .... Type Filter Material ..... .............Depth Filter Material --..... .............................. Distance to nearest: Well . ................... Foundation -. ................... Property Line ........................ SEEPAGE PIT [ 1 Depth ...... ... ... Diameter .... ... Number _..................... ... Rock�,Fliled Yes ❑ No Q Water Table Depth .............................. . . ...........:-Reck Size ................ -.. �.Y....:: Distance to nearest: Well ....................... ..............Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ......................................u..... Date ..-..r....-...--..---..-.......-) h D,i Septic Tank (Specify Requirements) ........ l T'.-�f�x.. ._.... T..L.'...-..u...... ... {H-..y.NF......Vh.5r._&X Disposal Field (Specify Requirements) fioR.....FU7VRE....Lr-X?ANJ1-.QN- .......... ....�-.,�.-..� A - r-� Z_ .......50...`........04.1..NzsS....._ 4:7._..W.....-....W..Q.�.........[.........ZY...... W)Dom....- 2- - Sr_EPACW�......Pf.r... . X.io '._x...II.y-! ro;.. .._SA.N.D.,........... (Draw existing bnd required additior, on reverse side) I hereby certify that I have prepared this application ar-d 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 b rye subject to or s mpensation laws of California." Signed I _ kJ . _ .. ._ /j!'L Owner By _.........................._.. ................ �A R.. Title . ........ . ...... -1............... (If other than owner, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..."T-A R-0 ... .............. DATE IJ- .� . .'. .,....... BUILDING PERMIT ISSUED ...... . .. .. ... ... .. .. ... . ..... ..... . DATE _... ... ............ .... .......... . ADDITIONALCOMMENTS ---- - _.._ ......... ..... .._ .. .....-....-..........-....... ....._...-.......- . .......... . Final Inspection by: Q� Date SAN JOACUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M