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FOR 0-FFICE USE: k.. APPEICATION FOR SANITATION PERMIT _.._........... .::`' -.-.-:_ --............... (Complete In Triplicate) Permit wv_,-7 7:5..... -._ ... Date Issued ...�...... --------------------------------- . _ 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ........ _ ./ISo%t/.Iif� -- ,Cf�T ?CENSUS TRACT .......................... ! Owner's Name ..... lam-S. �.�ll'6> f ...... nLne ... -..._...........----... ............. .: ... . .-•---....-. city .........Address .._ .... ...................... . Contractor's Name ----05+ �ss�-.�...........License Phone ...�',�... 4-3 Installation will serve: Residence❑Apartment Houseo Commercial❑Tra€ler Court 0 i. Motel A.Dther Number of living units:�� Number of bedr ms ��Geearb��ag--eGrinder ............ Lot Size •,�f....;�.-��..��?.��..... Water Supply: Public System and name ---- -..L _ L ....................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam 0 Hardpan❑ Adobe Fill Material ............ 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) lY PACKAGE TREATMENT ( ] ,SEPTIC TANK Ij .._ Size.................................................Liquid Depth .......................... Capacity -----------•----••-- Type ---- --- - -------- Materla[- `--' *--------- No. Compartments; 3 Distance.to nearest: Well ...Foundation .. Prop. Line . LEACHING UNE [ ] No. of Lines _ ____________________ Length of each line............................ Total Len th .. ' 'D' Box ... s. Type Filter Material Depth Filter Material A ..' .._. ................ ... " Distance to nearest: Well ....................'. Foundation -�..._..._.... -------- Property Line ....... _ SEEPAGE PIT [ ] Depth ...a`?„ �. Diameter _(,Z'S..... Number ........�� ............. Rock Filed .Yes No (I N Water Table Depth ...... -- --._:: ..... .........Rock Size .•�-lt-..�/��t�..-- 0 Distance to nearest-. Well .. .. .. - ..........Foundation ........... Prop. tine ...S.............. 3 REPAIR/ADDITION(Prev. Sanitation Permit+# _-----.---- ._.-----.- ------------------ Date --.=....................•......... ) Septic Tank (Specify Requirements) - _ - - ._................ Di osal Field {Sped y Re uirementsj .� /.d..-, ... ,r - !�...... ...... _ _.._ 1a7 - a� 1w,--9 ='---------------------.------.. ............... '!I - -(Draw existing grid required addition-on-reverse side) - ` I hereby certify that I have prepared this application'and that they work'-will be done In accordance with San Joaquin County Ordinances, State Laws, ani) Rules and Regulations of the San Joaquin local Health:District. Hance.owner or licen- sed agents signature certifies the follow'r_g:' r "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 becam s bject to Wo*m n's C mpensation laws of California... { Signed __.--- • -- ----- ... ... -------------- Owner --•-------------------------- Title --- (If of er than owner}_ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . _ . . _ ------------------------------------- DATE . ". J { BUILDING PERMIT ISSUED - ..-._DATE ._• ----------------- ---------- ADDITIONALCOMMENTS _---•-- ---------------------------------------------------•----------------•------------------------------------------------------------------......... - final-In ._.-.. -• -------- ---------- --------------------------------------._.. _------------__._.-.._. ..._-. _. �.�._: _........_....... --- - Inspectionby: --- --------- ............................•-•--•-..............................._...-•......Date --.. .- ._..---- IEH 13 2b 1-613 ltev SAN JOAQWN LOCAL HEALTH DISTRICT 8/74 3M