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FOR OFFICE USE: - APPLICATION ICOR SANITATION PERMIT t..:...........:..... .Permit No. �— . IComplete:in Triplicate? .. This Persnit Expires I Year From Date Issued Doti Issued!.y . .'. - 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 mode'in compliance with County"Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. .L. .�Lf72 �................. ......CENSUS TRACT .......................... Owner's Nome AALq� `r'.. I-- A ° .................. .. ........Phone ./:-.9a ' ,2./. I I Address . . ........... ......... #2501 ...... ........................ ......_........... City r,.L .l 0................... .... e , Contractor's Name .. .0 r�r-tski... ...- ......License Phone .- Installation will serve: Residence ►partment House❑ Commercial❑Trailer Court ❑ 1 Motel ❑Other .................I.......................... Number of living un'its•_..-..( Number of bedrooms Garbage Grinder . . ....... Lot Size Q. ' Water Supply: Public System and name ............................... _ ..............Private ❑ Character of soil to a depth of 3 feet: Sand b Slit❑ Clay .❑ Peat❑ Sandy Loam Clay Loam❑ Hardpan ❑ Adobe❑ Fill M6terlal ............ If yes,type ............... .. IPlot 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 TANK Size. �?�,��....... _ Liquid. Depth...:............ t ��" Capacity! _ TY Material` r No. Compartments ..:. .. . . ,Q .. . s Distance to nes est: Wel! _. ...............Fours tion ..... .. .......... Prop. Line .. .. LEACHING LINE No. of Lines ----..-t-------------- Length of each I ?[.. ..... Total Length ...�c�....�7..... ' Type Material Depth Filter Material ....I.-:l ................................. D' Box .._._'.__. . T e Fii#er p s DistancID e to nearest. Well �....q-Four tion .:s .. ...r:.... i'roperty Llne ..:.... ............ SEEPAGE PIT .[ I Depth -------------------- Diameter -_....... ...... Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ----------------------------------------Foundation ............:....... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# - ----..... -:---- Date ...................................I Septic Tank (Specify Requirements). ----------- ,-- ----- ................. ��,,� .. Disposal Field ISpecify 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 Mules and Regulations of the San Joaquin Local Health,Distdcf. Home owner or lion- sed agents signature certifies the Following: "I certify that in the perfor ce Of the work for ich this permit is Issued, 1 shalt not employ any person in such manner as to become subject n's Co pens Vows of lifornia." Signed.._�o ,� . ---- ..ai- _ Owner By ----------------------------------------------------------•- - — - - - :.:.... Title _. ....---..._.:.----......-................ .__. --- --- --- - - - ---- (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPT6 BY ---�--- - --- ------ ----- DATE ..f..7 _"._� . .. BUILDING PERMIT ISSUED ...................:...... ............:..... ......:............:DATE . ....--- ............._..._......_. ADDITIONALCOMMENTS ----------------- ---•...................................................................................•-----•-- •--.._.__...._..... -----------------------------------------------------------------------------------.................................... ..........................................................--•..-._._._ i ------------------ -------- --------------- -----• ------ ---------------------------...-----.._. ------- ----------- --- ----- -------------------------------••-------•-- .............. -------................. Final Inspection bY= ------- ..............................................Date ...2 .-...Z.-. 7 ........... Eli 13 2h 1-68 £Lev. 5I SAN JOAQUIN CAL HEALTH DISTRICT 8/7h 3M I