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FO'k OFFICE USE: APPLICATION FOR., SANITATION PERMIT ...------ - -------------------- --------- - pTriplicate) Permit No. r (Complete in 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .__J._ �-�.____e----------Lugg _"c _.---- anfe--CENSUS TRACT -------- ----------------- Owner's Name ...�t_ `--_0Q--r5__-_...----------------------------------- -----Phone ---------- Address ------:1 6_CJU ----- -------------------------------------- ------------ City ---- 7-ocIV_2a.------------------------------------------------ Contractor's Name . . f±-C-----J_:k`R K-------License # __ d d l----- Phone W 63'_2C>J4F Installation will serve: Residence tk Apartment House-[] Commercial []Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number ------------- ----------------------------Number of"living units:---J------ Number of bedrooms ___. ___-Garbage Grinder .i Z-P__ Lot Size ---S '?f-_124-7- -Z :�?--_._____ Water Supply: Public System and name ---------------------------------------------------------------------- ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam D4 Clay Loam ❑ 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ — Size------4____._X_4----14I_a._Ir------ Liquid Depth -----It4e-"______- V Capacity --,/_a-0_0___ Type _ __ __ Material_0Pf1CMt9__ No. Compartments ----- ....... Distance to nearest: Well ___________ �__�___________Foundation ----------'6-------- Prop. Line LEACHING LINE Nf' No. of Lines ____.I------------- Length of each line-------.�Q-�_.._____ Total Length ___ /�_ ..___._.__ 9- 'D' Box ____ _______ Type Filter Material --- Depth Filter Material __________�____ ______.........__._ Distance to nearest: Well --------- ------ Foundation ______A_0_________ Property Line -- r-----_-___ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ____________ Rock Filled Yes ❑ No I❑ Water Table Depth ------------------------------------------------Rock Size ------------------------ Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _..-----.---------.--- REPAIR./ADDITION(Prev. Sanitation Permit# _.______.____YLc0---------------------- Date ----------------------------------11 Septic Tank (Specify Requirements) -----------�.-�s�----- L-------------------------------------------------------------------------- -- DisposalField (Specify Requirements) ---------------------------•--•--------------------------------------------------------------------------------------•--------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------------------- (Draw --------------------------- ------------_--------------------------------------- (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 yes------------ --- - it Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -------------- ------------------ --------------------------- DATE ---- ��y- --------------- ----- ------------ BUILDING PERMIT ISSUED _.___._____________ DATE _.-------------------------._ ADDITIONALCOMMENTS --- ------------------------------------------------------- ------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- -----------------------•------------------------------------------------- --------------------------------------------- ------------------------------------------- - ---- - �- r - --------- -- ---------------- Final Inspection bY,- ---------- = - C.��= Date __..CF 18 -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M