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FOR OFFICE US ' q APPLICATION FOR SANITATION PERMIT ........................... go....... : Camplete In Triplicate) Permit No. �:.S.S. .................................................. .If..." ` �. .................................. . . . . This Penult Expires 1 Yaar From Date Issued Date Issued Application Is hereby made:',to the San Joaquin Locol'Health District for a permit to construct and install the work heroin described. This application Is made In compliance with County.Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION .......��17 L. ........................... ....CENSUS�TRACT ........................... Owner's Name ... ... ................................................... .Phone .. :Z; O, .......... Address ...... . L7.�i - - `Cliy `...... .:... .. .... ............................................� / `` Contractor's Name::.......... .................License # phone r y ... .............................. installation will somh I Residence- Apartment,House❑.Commercial❑Trailer Court ❑ Motel(]Other--_-........................................ Number of living units......... .. Number al-beds arra 4.....Garbage Grinder Lot Size �� i' � — E .��..��:4-�!�'::�:. .Private.............. Water Supply: Public System and nc�me—i _..:_,.... ...,......................._.._...�... .....---•-•• ❑ �} Character of soil to a depth of 3 feet: Sand❑ Silt❑ . Clay ❑ peat❑ Sandy Loam.❑'• day Loam ❑ Hardpan 0 Adobe 1�_Flll Material .` (Plot plan, showing size of lot, locafion 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 -I-] SEPTIC TANK( I Sire................................................ Liquid:Depth,\......................... . �i�' ci .................... T ...... Material.........._........... No. Compartments; .h► nearest: Welll.....................................Fpundation .......... _...... P a .Line ..•=............. . Dista ce to ea p• � �-=,- LEACHING LINE ) Nof Liniz—.---_•-- ------ .._E.angth of ead►Ilse.... ........ Total Length ........`................. i 'D',;Box ..........._ Type Filter Material .................. .Depth Filter Material ..................... ................ Distance to nearesh Well ........................ Foundation ............ ...... Property Line .................... SEEPAGE PIT E ) Depth ...-. ..._------ Diameter ...... Number :........................ . Rack Filled Yes-0 No ❑ Water Table Depth ----•......... . ..:...... ...................Rock Size ............•••............,... a ` Distance to Well==` •......................'-.Foundot3onf. .........-......._. Prop. Line .�.._.....--.... ,... is � ......... Septic Tank (Specify Requirements) ...... ..:................... � .� 1 r Disposal Field (Specify Requirementsy ......- . ... .. .......................................... a� ........._..------...........=....�. .:- ... ........................................... (Draw existing and required addition on reverse,sidel I hereby certify that I hav'prepared this. application and that the work will be done En accordance wltli San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifi"s the following: "I certify that In the performance of the work for which this .permit is Issued, I shall not/empley,any person In such manner as to become subject to Workman's Compensation laws of Californla." ; Signed . Owner B f xitle `� .... .......... �/ .............. ...... . ....:..... r........................ ..... ......_.. (if oth t an'owner) EPARTMENT USE bNLY F APPLICATION ACCEPTED BY .. DATE ..... �:.. -, , ......... BUILDING PERMIT ISSUED;...--- .. .... . •.............. ..... ...........................................:.........DATE ........................................... . AI ITION OMMEN .. ....................................................................I...------............ %% r ..:1 .......................................... ............................ ..........:G......... .. .... . ......... . ............................................................ .... ............. ..................... .................Date .... ff� ..�./...-............ EH 13 24 1-6if SAN JOAQUIN LOCAL HEALTH DISTRICT /171h 3M l