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APPLICATION FOR SANITATION PERMIT .........................................I............... (Complete In Triplicate) Permit No. . .].�.-..�4�L ........ This Permit Expires 1 Year From Date issued Date hrued .fib:. 5: � Application is hereby made to the San Joaquin Local Health District for a permit to consti d and install the work herein described. This application Is made In compliance with County Ordinance No. 549 and Isting Rules and Regulations: JOB ADDRESS/LOCATION ... .. .'.�:.�.. 1..1 .... dxCEAISUS TRACT ......... Owner's Name ............ f � ......... ` �c ... f . - .. :.. .. �.. ... .. t. :.�. P.h..o..n.e.. .............................. ...9. .. Address ..... . 0 .....l w! ..................................... Contractor's Name . cense ThaneK��.��.. In will serve: Residence Apartment House fl Commercial❑Traller Court ❑ Motel[]Other............................................ Number of living units:-_..� Number of roams .. 9 .....Garbage Grinder .. :. Lot Size ... .... .. .•............. Water Supply: Public System and name .. . ... ... ..._ .4........_.......................................... - Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ Hardpan❑ Adobe 9 Fill Materia! ............If yes,type........................... (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitt If public sewer is available within 200 feet,( PACKAGE TREATMENT { ] SEPTIC TANK{ 1,671S t`/ Size..........................................I... Liquid Depth .........................� Capacity .................... Type .................... Material...................... No. Compartments .....------.........o Distance to nearest: Well . ....................................Foundation ...................... Prop. Line ..... ........•� ..... -- LEACHING LINE W No. of Lines ....... ............... Length of each lyine..... ..��.�............ Tota! Length .,94Z,................ 'D' Box . ... Type Filter erlol /.Q.-Gly ...Depth Filter Material ./91._............................... [� • . Distance to nearest: Well ......... Foundation _1,�......a....... Property Line ' ............. ` . SEEPAGEIT Depth --........ Diameter .._._.. Number ..... ...................r�ack filled Yes Cr No co Water Table Depth ...... ............................Rock Size ..c2.... .................. Distance to nearest: Well ....Zaa.......................Foundation .._. Prop. Line ................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................l Septic Tank (Specify Requirementsl ......... . ........ .._ Disposal Fieloi (Specify Requiram tsl .� ,,�-t �" .......... ... ...._•........................................ .. .... . .. .. ... s• __ •.�. . .. .. ,•�jj""",,,,�,...•► . .............................................. ................................•............................ ........_._.......__................_................._...................................._. (Draw existing and required additlon 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 )icon- 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 ..........L 8y .._._. Title ...... ......................... Aothe; anowner O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... a--, d S ._. . . ...... ....... .. . ................ ..:.y DATE .......�.. BUILDING PERMIT ISSUED .--•---•................................. .............. ......... ........... ' DAT): ADDITIONALCOMMENTS .............................................................._..._-._...-................... ......................... ......... ............ -... ....... ........................................ ....-................---..................... Final €nspection by: ..Date .../..- .. •-•-- 13 2!t 1-6F3 llcty. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M