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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,.'�.:.3.v Permit No. ... .. ..... /.. (Complete in Triplicate) 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: J08 ADDRESS/LOCATION ........., -`�.�Y. r.Si4�11..:_. .iOg Lam *..........................CENSUS TRACT ; Owner's Name ... .i li-i�J{:.l. ............ ..... Phone.��' ?:a:7 ... ... E Address ................ ? Lam: !4�.f' .. GS ......-•--•... City ... : '4^�.......------- ....... .. i`f _r P+r 5 �-c_ Contractor's Name .........�•. .... .............�5......�.....•-...... .......License #c. Phone Installation will serve: Residence 121 Apartment House❑ Commercial❑Trailer Court 0 Motel Other Nvmber of living units:......... Number of bedrooms....:3-..--Garbage-Grinder..............Lot Size...... ..._...--_-- Water Supply: Public System and name ............ ..... .Private ❑ Character of soil to a depth of 3 feet: Sand❑ .-Silt❑ - Clay'❑ Peat Q Sandy Loam ❑ Clay Loam ❑ C hardpan ❑ Adobe Fill Material ............ If yes,type _......................... ' f , (plot plan, showing size of lot, location, of. system in relation,to wells, buildings, etc. must be placed on reverse side.) 3 NEW INSTALLATION: {No'septic tank.or seepage pit permitted If public sewer-Wavailable within 200 feet,) I PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size.........................................:...... Liquid Depth'............................ j Capacity" yP P . ...................... type ..:...........---•-- Material....................:. '-No. Compartments -•-.--•----........... Distance to nearest: Well .foundation ... Prop. line ...... ............... 6 LEACHING LINE [ ] No. of linesg g -�------------••-------. Length of each line..----------•...........:... Total Length ........................... W `D' Box ............ Typefilter Mafierial""" .Depth `Filter Material ------_------- ........... Distance tonearests Well ............... Foundation -----------------=- Pro e" Line - SEEPAGE PIT j Depth Diameter.................. Nutmer ............................ Rock Filled Yes ❑I No i❑ , Water Table Depth i' ......:......•---...........:..._......C.:......Rack Size . . to'nearest: Well ............................Z..........Foundation .................... Prop. Line ...............Q REPAIR/ADDITION(P. v. Sanitation'Permit ......................................... Date ....................._..._ ...... �. Septic Tan Specify Requirements) Disposal Field (Specify Requirements) ........_...` •= _A:. - -IQ M.................... 3 ...?..-------------•-• - ----- ------••--- .................... ................. f .......................I—............................................................................. ------••--•- ...................................................------------ (Draw - ----.(Draw existing dhd required addition on reverse side) Dj I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joacluln. County Ordinances, State Laws, anil'ROes'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, l shall not employ any person in such manner ` as to become subject to Work n's Compensation laws of CallForrtia." t l Signed ........ . .... . 1... --- ....... ----- ............................. Owner I B ...._.. Title .. ................._..__................•---•............. Y ................. ...... �i ............... (If other than owner) " FS&Qf PARTMENT USE ONLY APPLICATION ACCEPTED BY .. - ,. .............................. DATEJ'�.`........--- ..:`--.........7 BUILDING PERMIT ISSUED ......... DATE ADDITIONAL COMMENTS ............................................................................... ..................--------•-------.. ............ ---- -- --• - --- .....•--...I._......--••-- -------•-• • Final Inspection by: ---......../ ..... . ..------. . ........ ..............Date ............:...... ......_ . k / %' SAN 'JOAQU L LOCAL HEALTH, DISTRICT k E. H.13 24 1-'68 Rev. 5M - - - - 7/72 3 M