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F°.. OFFICE USE: (, APPLICATION FOR SANITATION PERMIT •-�--......-.. {Compfeh In Triplicates .... . ...............I.........._..--- Permit No. ..................... Data issued .. This Permit Expires 1 Year From Date Issued Application Is hereby made to the San Joaquin Local Health District for a permit to construe! and Install the work herein described. This application Is made In compliance with County Ordinance No. 549 and irtisting Rules and Regulations: r �JOB ADDRESS/LOCATION ..... -T� f---•----- ...._../._.�..N:....................................CENSUS TRACE ..---........_............ Owner's Name ....._... .,,�...L..,p Q..� � r..../&� 1 ............ .............................Phone .................................... Address .... L1. ..-...... nJ......................City ... ................................. Contractor's Nam .Q�. -- .�kms....................................License#a. Phone installation will serves Residence❑Apartment House Commercial OTM11WCourt ] Motel ❑Other............................... ............ Number of living units:__._ ...... Number of r ms ....2,...Garbage Grinder , ©.. Lot Size .. :: ., ...�. ........... Water Supply: Public System and name . _ .._. ..... .......� .... ._ ....---..........................................Private ❑ ' Character of soil to a depth of 3 feet: $and❑' S It❑ Clay 0 Peat❑ Sandy Loam(3 day Loam ❑ Hardpan❑ Adobe ill Material.............If yes.type............... ............ !Plot pian, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) i4lWINSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth ..........................�.1 Capacity ---•---------------- Type, .................... Material...................... No. Compartments ...................... Distance to nearest: Well' .."-.............................Foundation...................... Prop. Line .................... -JDk I TEACHING LINE I } No. of Lines ........................ Length of each line............................ Total Length ........................... rn `D' Box ............ Type Filter Materia! ............. .Depth Filter Material ............................................ , . „ Distance to nearest: Well ......................... Foundation ........................ Property Line ........................0 SEEPAGE PIT 4 ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑�� —� Water Table Depth ............................ ...............Rock Size°.—............................ i Distance to nearest: !Nei!...................... ....... Foundatlan .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date ......... ..................... .) Septic Tank (Specify f%equirements) ..... ....................: V..J.......... .. ,._................ Disposal Field (Specify Requirements) ....... ..... . ............... ....... ................................................. i /<...-- •-�� -• =� .... ............................................................................................... I -- .................................................. ..................................... (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 Son Joaquin Local Health District. Home owner or Ilcen- 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" 51gned ..............................._...... ------------._.... ............... Owner . By ..... ...... .. ................. .............................. title ..................../.../. rr .. (If other than owner).- " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ................................................. DATE ....... ;7.. .:. BUILDING PERMIT ISSUED ............ ..... ......... ............_ •----...................DATE......... ...._...._.: ...._........._... ADDITIONAL COMMENTS ...... �Z9` -------- .. ..................................... _......._..._.. � ..................... ...--•........................................... ------- --------"...------------------ ._._..---- .. .............w. ._..-- .......-...-_. ..................... .._........ ...... __---.....__.... .. . -..._ - :........ ..... . . ......... . Final Inspection by: ...__-.... Date ....... .. �._.�. . ....---• EH 13 2h 1-•613 lay. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h