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FOR OFFICE USE: • APPLICATION_ FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _;<-_7 L-- This Permit Expires 1�YearFrom Date Issued Date Issued Application is hereby made to the So 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 - 2b3bNO_,---Wil s0 ?_WAY____.__-- __ ------ ------CENSUS TRACT Owner's Name ---Lin_0_-_E-.___Aac-1a1_o1- ------------------ L ------------------------------------ -------------------Phone ------------------ Address ___ ' 18V.3r Dr, -CityOrnd.a..-- _.._ Bla - - - - ' ' - - - Contractor s Name --_--_____CkOrd--__-S QR-t_,_c___ ,qn -------- I------------- License # Y2(ag5i-------- Phone -4.j.- Installation will serve: Residence E] Apartment Apartment Hous ❑ Commercial ❑Trailer Court :E) Motel ❑ Other ------------ r"` + Number of living units:.--__ ----- Number of bedrooms -------------Garbage Grinder ------------ Lot Size -----1-_Ar--r_e----------------________ Water Supply: Public System and name ---------------------------------- - .-C-i_ ----------------------------------------Private Character of soil to a depth of 3 feet: Sand'EJ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan E] Adobe ig] Fill Material ------------ IE f yes, type ---------__________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be, placed ;on reverse side.) P NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT i ] SEPTIC TANK'[ j Size--------------------------------- ------- - _ALiquid Depth Capacity -------------------- Type ------------I------ Material---------------I-----`_ No. Compartments {... Distance to nearest: Well _______________ i ` --------• ----------.Foundation ------------- -------- Prop. Line ...................... LEACHING LINE bC) No. of Lines ---1---- -------------- Length of each line-------1 ._._-__.____. Total Length __-_15_• 'D' Box ----1_____. Type Filter Material~------2,"---------Depth Filter: Material -----1- Distance to nearest: Well ---------....,.,_------- Foundation � a-- ------------ Property Line 1-5-1----------------- SEEPAGE PIT ] Depth ------?5.______-- Diameter -----4 "---- Number ----------2 Rockl.Filled Yes ® No iQ Water Table Depth -----------90--1--------------------- Rack Size 29 Distance to nearest: Well -------—.,.,,.------------------------Foundation ___159----------- Prop.Pro Line ---15_............. REPAIR/.ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______--_----_________ } Septic Tank (Specify Requirements) _____________________ Disposal Field (Specify Requirements) ---------15-'----Lea,oh---1,1ne--- ------------------------ - --- ------------------- - - ------- - ------- -------- - -------------------------- (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 ---- --------------- ---------- -- --- ----- BY ------ -- .--------- - ------- - Title _.. s _ ot er than owner) ------------------ EPARTMENT USE ONLY APPLICATION ACCEPTED BY _-._ __ -- - ------------------------------------------------------------ __ _ DATE _- —_ -_ ----- BUILDING PERMIT ISSUED ----- -- _ _ -------------------DATE ----------------- -- -- ADDITIONAL COMMENTS trn / _-- �� s - -------------------- ------------I-------- Final Inspection by: ----------- - ---- - - •----- Date.-- SAN„�OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev.