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FOR OFFICE USE: y APPLICATION`FORS SANITATION PERMIT .�. ... .6.............. Permit N P. . a a...:.- (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Date Issueda:-3�:- ,� Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: 'L/ CENSUS TRACT JOB ADDRESS/L MON .... .. ....._ ,c._... G --..- ..._. •--•-------- .......................... s Name l�' ---•---------- --•....:.... ......... `.... .......Phone .........- . ..•... ............. Address ...... City _......... ........................................... ' Contractor's Name _._.. -------- . •- ......... -----•.........................License # .��.7� - Phone'.. Installation will serve: Residenc artment House❑ Commercial❑Trailer Court (] Motel ❑Other --------•-- -------------• --...:....-•--•- I Number of living units:....... ... Number of bedrooms .43—..Garbage Grinder .F Lot 1r3� ...el'. `�-! a .... . - . F } Water Supply: Public System and Warne ............................---•-•--�----:.............-----.._. .........-----........Size .................Private .f:�� r - Character of soil to a depth of 3 feet: Sand ❑ Silt❑ s Clay Peat❑ Sandy Loam fl Clay Loam D Hardpan ❑ Adobe Fill Material ?4442 If yes, type (Plot plan, showing-size-of-lot,-location of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: t : (No septic tank or seeps it permitted, if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK �....f, ........................ Liquid Depth ./...'. .............. ' Typ / a Capacity Material No. Compartments - �J Distance to nearest: Weil ..... r . .. ..........� ...- •-••-----Foundation ................. Prop.Prop. Line�'�......_.......------ � LEACHING LINT: [ "No. of Lines ..__.J................ Length o each line.___ _ 3l Total Length � = •D' Box A) Type FilterMaterial .' Deptli Filter Materia( f Distance to nearest: Well --.1---f ....... Foundation ... -.------. Property Line .5 r........•....... ' nr SEEPAGE PIT—[ Depth-. _ Diameter ` L... Number ...............•_ _._______. Rock Filled (Yes o ❑ Water Table Depth ------ �. ......................Rock Size/ki-X--_ --------------- Distance to nearest: Well -------- etO--- ._. .Foundation ..1�.i........ Prop. Line .6..`...... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- Date .................................. S f i Septic Tank (Specify Requirements) .............. 7------------- Disposal Field (5pc1y Requirements) - i ----•............... t � _..-----•......... ......:............................ -----------------------------------------J............. ---•-- ---------------...........I........... ..................... (Draw existing and required addition on reverse side) I hereby certify that JI,have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws,' and Rules and Regulations of the San Joaquin Local Health District. Hama 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 manner as to become subject to Workman's Compensation laws of California." + i Signed ..-•---------------.... ---- •....................... .... .._............................... Owner BY ................................ ..:....... ----- Title ...... 7. ... ........ .. ... .. .. (If o an owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---.... --------------------------------------- .......... DAT!~ ../� .._ . ..._ ... ...:.... BUILDING PERMIT ISSUED -- . ..............................................:..............DATE ....••. ..._ ..._..... ADDITIONAL COMMENTS ......... •-- --- . .. .. __� - ........................I--.-• .....................................--...:... ....................... ... .. .... ..... .................. ••------flil 1a. �.:_......: .........._.. •-••............. .1 ....... ./-- -��--�•-.---��......_...---••----........-•-•-- ....... --- - ------ - --- -------- •----------•-----•-----------------•----•-•-------....---....---•-•---------••--••--- ...._. Final Inspection by: ... ...........Date . :z�'.7 -_-- `"''- -- ' USAN JOAQUIN LOCAL HEALTH DISTRICT - ' E. H.13 241268 Rev. 5M 1 7/72 3 M, ��