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r -1=0R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: _-------.-�--••--- (Complete in Triplicate) Date Issued ___3��'�. This Permit Expires 1 Year From Date Issued . 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 Rules and Regulations: JOB ADDRESS/LOCATION . - - -------1 YR C �� 's------------------------CENSUS TRACT ----- P Owner's Name - t4l_- U -- -- ------------------------Phone ------------------------------------- --------RONG � L ;; City �SC/ LX/ i Address ----------/�- -----15----- �Q�1----�V�i Contractor's Name ------ ----------------------- V---------------- # ---------:-------------- Phone ----------------------------- Installation will serve: Residence Fepartmeint Hduser�E Commercial-07.railer Court ;❑ Motel E] Other ----------------------------- -------- -------- -- ----� Number of living units:----- ----- Number of bedros :__Garbage Grinde/ �� ---------- S Lot Size ____----_ _ ____ _ ('_ �, ��?�_ Private Water Supply':=Public System and name ---------------- j �--------- ------ Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑�k\. Peat❑ Sqn r Loam -[Clay Loam .❑ do e ❑ Fill4Mate;ial ------------ If yes, type -------------------- 1: l \ �� ' (Plot plan, showing size of lot, location of system in relation to wells,ibuildings etc. must be placed on reverse side.) to NEW INSTALLATION: (No septic to k or seepa a pit; ermitted if public sewer isavaila le within 200 feet,} PACKAGE TREATMENT { ] SEPTIC TANK,[ I Size-------------- -`------------t----------- --- Liquid Depth ----------------- -:--- --------Y Capacity ----- --�-�' TY{e. ( Materia N`` Compartments -_----•-••---------- Distance to nearest: 1�V' 11 ---------- -------------- Foundation ------- ------------- Prop. Line LEACHING LINE [ ] No. of Lines ____.__-_______- ------ Length of each line_._____-\___1------.---- - Total Length _.-___-•___.____---------. t ------------------ Filter M teri- -------------------------------• ---.----•- Distance to nearest: W I M.__,.^;.-.-_T._ Foundation ----------- ----- Property Line, ________________________ SEEPAGE PIT Depth Di meter ___ _1-- _ Rock tilled Yes No ❑ 1 p Number - -i;- ❑ Water Table Depth ----- -----------=-----------•-------- -------1Rock Size: � _ -----------"yDistance to nearest: W -------- -,,'Foundation �_ ----- _-``---- Prop. Line -------_-•-_-•--•- - s REPAIR./ADDITION(PPr_-ev. Sanitation Permit+ ---- ------------------ jjDateYY-------y-------- ---------------1 Septic Tank (Specify Requirements) ------------------------------------------------------ -I--- -- --f 0------- ��------- Disposal Field (S,ecify Requirements) ______/.,5-7r -L------------- --- 3 --- ---hi�-'�-- I - - t �,111 ----- ----------------------------------------------------- - s.•.-�- Y- ,IV- �- '(Draw existing and required-addition-on rev sekside} I hereby certify that I have prepared this application and that the work wilrbe 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 i .t performance of the work for which this permit is issued, Ial1 not employ any person in such manner as to becom ct to o ma�ompensation laws of California."Signed '_ .- .-�- ---Owne-- ' ti - ------------------- ---- BY ------ --------------------------------------------"��--i-"�-`a---^--`-"�-+��''�---- Title _.__.�_-:�--•---� ---- ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------1 1-X5.`40------------ ---------------------------------I------------------------- DATE BUILDING PERMIT ISSUED --------- ----- - ---------------;: DATE _.. -- -------------------- ADDITIONALCOMMENTS ---------- --------------------------- ---------- --- ------------------- ------------------- ---------- ----------------- . -------- ---- ---� --- ------------- = /-�. ------ ----- -- ------- -- ----- ------ - ------------------------------- ------------------ _�_ ��- .- J --- ---- - ---------------------------------------------- --------------- ----- ------ - ------- -- -- _ - -------------- -- - - r ) Final,Ins ec a .._ . .___ - _ p — r +SAN�JOAQUIN LOCAL HEALTI-6ISTRICT E. H. 9 1-'68 Rev. 5M.