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Signed <br />By <br />r • <br /> <br />Owner <br />jitle <br /> <br />.(if other than owner) - <br /> <br />*4 <br />, FOR -DEPARTMENT' USE ONLY <br />Date Final Inspection by: <br />ADDITIONAL COMMENTS <br />EH 13 2h 1-68 Rev. 5M AN JOAQUIN LOCAL HEALTH DISTRICT 8/7 4 3m <br />APPLICATION FOR SANITATION PERMIT <br />(Complete In Triplicate) „ <br />This permit Expires I Year From Date Issued <br />Permit No X'-77i <br />, Date Issued -,?-/O -1-74 <br />- I <br />rUK Larrig-c uoc: <br />Application is hereby mode to the San Joaquin LOcal Health District for a permit to construct and install the work herein <br />described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: ; <br />! . ao, - • 1 <br />JOB ADDRESS/LC:CAT), <br />Owner's Name <br />‘L-41--1. i c <br />-ite20-6t-P-6 <br />Address ........ I.!-+:3 )1 a elf <br />. . <br />Contractor's Name J License* i Per 22-7' Phone <br />... r 4 <br />Installation will serve: . Resi enoe Apartment House 0 Commercial 0Trailer Court 0 <br />,........., . '1 - . ... 44.C. ' , Motet 0 Other • - 1. <br />N umber of living 'units:_. I "'Number of bedrooms '.:3--- Garbage Grinder ' Lot Size <br />Water Supply: Public System and name' . <br />, . ,- -- `t, Private 0,-,----1 i • <br />Character of soil to a depth of feet: Sand El .1 Silt d Clay 0 Peat 0 San_c_rlyoa L. rn 0 Clay LOam 0 - <br />. ' Hardpan-re' Adobe-0- Fill Material - - If yes, type 1 '.. <br />, . , : i ; <br />(Plot plan, showing size of tot, loCation of system in relation to wells, buildings, etc, must be placed on reverse side., <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet) <br />PACKAGE TREATMENT [ 1" SEPTIC TANK I )7' Size Liquid Depth <br />Capacity. ' Type . ''' ' Material No. Compartments <br />$ I Distance to nearest: Well Foundation Prop. Line' i 0 <br />i I .4 <br />LEACHING LINE [ 1 No. of Lines . ' Length of each tine Total Length, <br />1 D. Box ' ' Type Filter Material ' Depth filter Material . 1 1.11 . s , , <br />Distance to nearest: Well Foundation Property Line <br />SEEPAGE PIT ( 1 Depth t, ' Diameter Number Rock Filled Yes 0 No a , <br />Water Table Depth <br />r , <br />Rock Size ' <br />• , Distance to nearest: Well .1 Foundation Prop Line <br />' , <br />REPAIR/ADDITION IPrev. Sanitation Permit # - Date I <br />I <br />1, <br />i, Septic Tank (Specify Requirements), , ' i -I - <br />; <br />Disposal Field (Specify Requirements) add <br />1 <br /> -..-. __3 <br />-,- . <br />P . <br />I — `(Draw existing and reOired addition on reverie side) <br />I hereby certify that I have prepared:this application aW•that the work Will be done in accordance with San Joaquin <br />County Ordinances, State Laws; and Rules and Regulations Ofthe San Joaquin Local Health District. Home owner or Iken: <br />„. , ., • , / <br />sed agents signature certifies the following: t <br />"I certify that in the performance of the work for which this Permit is issued, I shall not employ any Person In such manner <br />/ ,, . <br />I <br /> <br /> DATE ' / --I <br />, DATE <br />APPLICATION ACCEPTED BY, <br />BUILDING PERMIT ISSUED <br />ai to become subject to Workman's Compensation laws of California."