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FOR OFFICE USE: /APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. L_3-7.��_�_ r .................... This Permit Expires 1 Year From Date issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to consTruct�and linF]II2the work herein described. This application is mode In complier ..Writ County Ordi ante No. 5and existing Rules and Regulations: __.14B ADDRESS/LOCATION ../... � / 1 ,_.. ..r �_ � t- .. ��t.. ! -�1 is ACT `f NSLiS TR Owner's Name. . --•-••....................................... ...... .............. .................................... (e Phone Address _.�"_.._...�_._._...__..I.. ---- . ............ City ................ . . .. ........................ ............. ............ Contractor's Name -- .. ---... 4..-• ................License # 1.ff_.W y Phone . Installation will serve: Residence ❑Apartment House C] Commercial oTrailer Court 0 /. Motel ❑Other . ..� �------- Number of living units:.....(_..... Number of bedrooms .......Garbage Grinder .._ -------- Lot Size . �'._ �"�- ............... Water Supply: Public System and name -------- ........ ........................................_•....................................... ...........Private Character of soil to a depth of 3 feet: Sand n _Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type ............................ {Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. trust be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT � �JL E SEPTIC - Sia® . .. -.....•. -• X- • Liquid Depth ..--------............... Capacity �_h��_� Type .. Material.....< .,. No. Compartments _....l...... 'Z Distance to nearest: Well _.......tea f Foundation ...1_Q..f...__.... Prop. Line .. 6. ........... 1 LEACHING LINE No. of Lines ` [ ...-�--.�------------- Length of each line--....-•----•-----.._....--- Total Length l.J ...--_--- 'D' Box _ Type Filter Material $. Depth Filter Material ../l....................................... Distance to nearest: Well ...... ` -�......... Foundation .....f.-Q.............. Property Line ............... SEEPAGE PIT [v/ Depth �� .�. Diameter ..... .��: • Number ---_--__ �C ....... Rock Filled Yes No Water Table Depth �Od ' Rock Size / 3 p -------•--•----- ------. ---------•--...... Distance to nearest: Well .............. ! ` -...... ..............Foundation ..... P......... Prop. Line .... .................. i REPAIR/ADDITION(Prev. Sanitation Permit# _ Date ) SepticTank (Specify Requirements) ......................................... ........................................w.............. ----•---r..............------............ Disposal Field (Specify 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 Rules and Regulations of the San Joaquin Local Health 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 manner as to become subject to Workman's Compensation laws of California." Signed ............................................ ...................... Owner dam` • Title u � By ........................... ........ (if other than owner) 42 FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY .. DABUILDINTEd �.` s ADDITION PERMIT ISSUED _.......-•---------------------------•----.......--•--------...--- .......................................DATE ............---•-• ...................ADDITIONAL COMMENTS ...........................................:..•--.......---•-••-•--------•.._...............-•---•-•-•-----------------,.......---:.......................... . --------------- -•-----------................--•---...._..•---•--•---•--•-------•-•-•-•--•--•--••---•.....-------=----------•--•............._.........-•---•-------• ..............---............ ............................................. ......................... ................................ .....................................................--............. -------------------------------------------- - --- --- ----------------------------------------•------••--•--•--•-------------.._.._.........�. Final Inspection by: .... .-----•-----------------•--......------...----.........----•--• ..Date Z.O.. ._.......------- SAN JOAQUIN LOCAL HEALTH DISTRICT V- Ll 13 24 , M- �..