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'FOR OFFICE USE: Y APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .....5............ 5� Date Issued .•••••••--•--•-•••••••••••.•.......................... This Permit Expires 1 Year From Dote Issued -V-�- 7� _ ' 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 in compliance with County Ordinance No. 549 and existing Rvles and Regulations: / I 4 ` JOB ADDRESS/LOCATION ,..1 ..._ �. .. .� :�x;. .�....''.� //�' �: 1., '_.....:.. EN5L15 TRACT ....... ...... . Owner's Name TT i' ' /_..��r _. _ .......... i .Phone. Address .....�r'��./oiq .... o••,�...--1W 4r '/ �.Gp .__rCity .. /.�7 � j. /�..-• � r ../i efw .....I.......... Contractor's Name ._. .., oa r_....._....._. .......... -.License #,VVXXY... Phone .�.. �%�a....._ Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ] . Motel C]other ..._..---•.--------••-•-•----------------••- Nvmber of living units:... ..... Number of bedrooms ---2-n....Garbage Grinder'.*P... Lot Size .47.Af&f_'P. _.......-:--_. Water Supply: PublicZystem and name .... ....................-.........�..:= ` --••-•----•...... Priva f } to Character of soil to a depth of 3 feet: Sand 0 . Silt❑ Clay ❑ Peat 0,f 'Sandy Loam JK Cioy Loam ❑ Hardpan [] Adobe❑ Fill Material .............. If yes, {Piot 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 avoilable within 200 feet,) V PACKAGE TREATMENT [ ] SEPTIC TANK Size—........--------- ... .._.....__ Liquid Depth ....................... Capacity ............ ....... TYPe .................... Material...................... No'. Compartments d Distance to nearest: Well ....................................Foundation ...................... Prop. Line ................... _-- 'LEACHING LINE [ ) No. of lines ........................ Length of each line............................ .total Length 'D' Box __......._._ Type Filter Material -..Depth Filter Matehal Distance to nearest: Well .........................Foundation ._.__..... ...... ,L Property Line ....................... SEEPAGE PIT [ ) Depth ................ Diameter ................ Number ..........-...........--_- Rock Filled Yes C] No Q Water Table Depth ............................................... Rock Size Distance to nearest: Well .......Foundation Prop. Line ` REPAIR/ADDITION(Prev. Sanitation Permit 0 _._..........................................Date .........................?..........I Septic Tank (Specify Requirements) s.................... . ........................................................... ..- Disposal Field (Specify Requirements) P,/ �¢� Q ` r�r�fl .�i.�? ..._ .......... 4 -•---------- xis X........... --------- ,•• :....._ •------------------------•----------------.-•--....---------.------.......---•---= .................................................. (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 laccordante with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health I 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 Fnanner as to become subject to Workman's Compensation laws of California." ' Signed ................ .... ..... Owner BY Title, II ......{Ifode .............. E o r than ow e FOR DEPARTMENT USE ONLY --- DATE .....3Jr�- 177`x:.._...... APPLICATION ACCEPTED BY ... .... .. ..... . ......... " BUILDING PERMIT ISSUED DATE -.. _ ADDITIONAL COMMENTS .....................••---•.... - ......................:.....•---......---•-----••- ----•--•--••--•..............................:... ..-----....7.......... ............. -•--•...•-•------•.. ........................................................ .... --- ....... ....--•----•-•---i. ....--••--•- ...........................•_••_•____•.._.............._....-_ .......... i.__• �• .............. Final Inspection by: ...:.. ...........Ddte _ _ SAN JOAQUIN -LOCAL HEALTH DISTRICT '� JF_ u 13 24 1_-An o_ c.. _