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FOR OFFICE USE- APPLICATION APPLICATION FOR SANITATION PERMIT _..................•-•--......• ..._......_. (Complete in Triplicate) _ Permit Na. .__ �,.____ This Permit Expires 1 Year From Date Issued Dote Issued .L.:.tel' 5�, 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 Inco (fiance with County Ordinance No. 549 and existing Rules and Regulations: 1 e �y 1M 7 t-G So cr " OFF JOB ADDRESS/LOCATION .................-•rfV,).'{At7_ .._.. T.......Si.D .........CENSUS TRACT .......................... Owner's Name ...................................Phone Address ... ......... .J .............. ..... City .............S:'I't7 +moi �� \ Contractor's Name ...__� '—T.!_ !_era?_._......5._ .w.0......................license -2..5.. .1.'7. Pho ...... Installation will serve: Residence 0 Apartment House Commercial❑T►alle►Court � t_ -' ` Motel❑Other.... ................��? Number of living units:.- .. Number of bedrooms -tV'`_._Gorbage Grinder "^ Water SuPPIY Public System and name � ....................................... ..............................Private Character of soil to a depth of 3 feet: Sand/❑ Silt❑•„_,.Clay- ❑ Peat❑ y loom 0 Clay Loam Hardpdn❑ Adobe❑ Fill Material ............If yes,type............... ............ Ul (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 j SEPTIC TANKIj ---cl.......-_ "4 2 ....... Liquid Depth ...!�:...x........,....� Capacity 11,0.v Type .................... Moterial..C4mfl-?Ar±-� No. Compartments ..... -........s Distance to nearest: Well --------1_P42..f..................Foundation.....1.P._........ Prop. Line LEACHING LINE 'ISI No. of lines -------------- Length length of each line..........cl.0._'.-.-..... Total Length .......lA.�........... I 'D' Box ............ Type Filter Material L.jLe. S.,(1VAepth .Filter Material ...........)..` ......................�. Distance to nearest: Well ......1..0._P'........ Foundation .........t:0..1........ Property Line ......s .'.........:.. SEEPAGE PIT J Depth ...Z•.,5'_...._.•_ Diameter Number .... ................ Rock Filled Yes)' No i❑ Water Table Depth ...............9?......... ----- ..................Rock Size .••- Distance to nearest: Well .........L!`V.'...................Foundation ...../..O5....... Prop. Line ...:a .............. ' 1 REPAIR/ADDITION(Prev, Sanitation Permit# ....._...................................... Date .................................. Septic Tank (Specify Requirements) ...:.......... ....................................... ............................................. ............. Disposal Field (Specify Requirements) ••----•....................................... t ( -------------•-- -•-- -------------•------------........----...............--•-•-----.....-••-•--••--.....-•---.._.........,................................ -------------------------- - -------- ---- --•---....•--...---•-----------••-----•--••----•--•-••--•--•---•••--•••--.................----- ............................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the workwill be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or liven• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." Signed 0100n_rt.Ik.D-----5-15- q;i ...--•----------------- -- - - . .. - Owner BY ........ �_ _ .... _.....t (If other than --------- Title ..... . .................................. . owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. LcJ DATE . BUILDING PERMIT ISSUED . .............. ADDITIONAL COMMENTS._ .... _....= = DATE . ...... .................................. .........--• -••--- ............... ...........................•........................... ..................... . ..... ...........:...•--- ................... .......'....... ._ ..__.. ........................ final Inspection by: __ ._._. _ E .. .. bate 4..� 13 21a 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7lt 3M