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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _........... - ................................ (Complete in Triplicate) Permit No. 2.3...". y ............. ...................................... This Permit Expires I Year From Date Issued Date Issued .. ��?_�7'3 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 .....` �....�r�..... `f ....._•_.•.............................CENSUS TRACT ...................... ---- Owner's Name /�i L �i �Y7'.e .......... ,............................... Phone ......... .......................... ............ .. . Address zeep----�_....../��'.,q:C17..-•------- . --- t E' G -------------- - -------.--. City --�%��.��.�.-----..f..�.......--------•-...................... Contractor's Name _, e:.� _ OE' S� /.�7.ff.1.��('.....]C_._�.--.�....................License #`-•--.:._..---...----- Phone Installation will will serve: Residence WApartment Housed Commercial QTrailer Court 0 Motel ❑Other ------- - ..- ------•--•-_-- .......•. ..... Number of living units:..--- .___ Number of bedrooms ----7...---...Garbage Grinder .Yr5 Lot Size .... ............ ............ Water Supply: Public System and name ..-_...._...•......................................••--.._....................._._........._..._._......_.__..Private gg Character of soil to a depth of 3 feet: Sand IZ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam Q Hardpon ❑ Adobe-Q 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$ rJF PACKAGE TREATMENT SEPTIC TANK [ Siae. . � -- -"- - ----------- Liquid Depth ..' .. ........___._._. -r Capacity . ----- Types-"-:frMaterial.._ <.i. No. Compartments ....a.............Ov 00 Distance to nearest: Well ___'�___G`Q.....................Foundation ..I.. A < ---------- Prop. tine ��----•--------. O LEACHING LINE [ j No. of Lines _._.__. ............ Length of each line.__)p .............. Total Length 'D' Box ...../---- Type Filter Material 1.Aj..A01_t✓!.1Depth Filter Material ............................................. ( .. Foundation __ ._.._ Distance to nearest: Well .f:�0.�...... �d�__.._--_-- Property Line .��`.-�---•--....e� SEEPAGE PIT [ 7 Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ ro Water Table Depth ....---•--•---•-•---•---....••..................Rock Size ------ ----------------- ------- A Distance to nearest: Well ........................................Foundation ...... ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) -------•.._....._..r-------------_ ------................................--_-------- ----------------------------------------------- DisposalField (Specify Requirements) --••....... ..... . ..••.......... ......................................_.._...--------------------------------------------------- --------------------------------------------------------............------------------- ------------------------------------------------------------------------------•-•------•----------•--------- (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 a-nd Regulations of the San Joaquin Local Health District. Home owner or iicen- 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 sX ' Io Workman's Compensation laws of California." Signed .-- /�1. Tlt 97/l/ Y4? Owner By _....._....� -'.C? ___.�_ .... ................... Title ............................................... lIf other ta9-oiivrie? FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...----- e04=......4... .......... DATE ........ - ��.... BUILDINGPERMIT ISSUED ...................................................................-------•-------........................DATE ........... ............................... ADDITIONALCOMMENTS ................................................-•------------------------------- ------------------------------------------------:..--_--•-•----•----------- I ..........................•---..................................................................................................................................................... .........---------------• . - - . _-- --- .............................. -----... --- Final Inspection by-, ... ....--- ---........Date .............1 ..... -- .......... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 241.'68 Rev. 5M 7/72 3 M