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FOR OFFICE USE: --• -------------------- APPLICATION r-OR SANITATIW.N-PEI;NIIT Permit No: -L.- - . ' (Complete in Triplicate! .................. ...... This Permit Expires 1 Year From Dote issued Date Issued Application is hereby mode 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. 54�on /existingRules and Regulations: JOB ADDRESS/LOCATION .- - I,�D_/I/ !C/ -,P.__-t`Oywc�t.._ ._CENSUS TRACT ... ................. Owner's Name .. ------- ! _x<a------------------------------- �j� ------•------�- ------.....Phone ...---------•----_.-_... Address ................. `> � .. 1.�L�CF [c2!�_v -ei.._{�sCity __,C` �-----------....................------------------------- --,� License# { .; } Phone _ r.._•.._f _ Contractor's Name -------- -----�....._..-- --------------...._--------......... Installation will serve: Residence artment House,Q Commercial ]Trailer Court 0 Motel ❑Other..................... f----------------- Number of living units:. -1---- Number of bedrooms _3.......Garbage Grinder i.--:_.--_ Lot Size ............... Water Supply: Public System and name --•-------------------------------- ------•--•-••--•--------------•-•-•-------•----•------------•------ ----Private Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay loam❑ Hardpan Adobe Y Fill Material _rl/Q..__ If es, - p ❑ Y 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,) PACKAGE TREATMENT O SEPTIC TANK I) �Siize _-_- ...a,S`�'J ....__ ----._.__.. liquid Depth _'447._____________ � Capacity .1-.24-0....... Type ofl!,1.aeMaterial....�.a ssL o. !Compartmentssem_/____--_-.... �1 Distance to nearest: Well --•-------------Foundation ._/Q-�. Prop. Line ,-__--- LEACHING LINE No. of Lines --------- Length of each IineS_r'_7�. Total Length v ryry it 'D' Box Iff,5— Type Filter Material _�_ _.J .. epth Filter Material __- __4_____________________________Distance nearest: Well ._ �.-..___.__ Foundation ..* .a �__.______ Property Line _t__4.......... -SEEPAGE PIT ,.3� Depth s _ ___ ____ Diameter 7 - p _ 1�___ Number ,�____ _____� _:. ___ Rock Filled Yes V No 0 Water Table Depth ------ , --------------------------_--Rock Site- ZZ''�-3 Distance to nearest: Well ......).A !.'.......... -_-/111-......._--- Prop. Line . --d______-___-- REPAIR/ADDITION(Prey. Sanitation Permit# ..............................----------_ Date............-__ ----__.__.__._...) Septic Tank (Specify Requirements) _-,-•---------------------------------------------------------------------L-:. ......................... --............... a Disposal Field (Specify' Requirements) ' ._.......-............................. - t — ---- --------------- ---•- -----------.....------.__-...-----------•---•-•-•-•----- (Draw existing and required addition on reverse side) I hereby certify that J. 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 licen- sed agents signature certifies the following: "1 certify that in the perfarmante of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -----•----- -- .....11. ----- - -- By ...................... --••---•-----••-- - lite . 10. . -.'1 .,,,- •- - (1.-of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ----. DATE __. _._"'.__._ BUILDING PERMIT ISSUED --------------.................................... ......DATE ........... ........................... ADDITIONALCOMMENTS .........................------------------- -_---------------------•--t-_------------------------••----.--•--•--- _------------------ ----- ----- .......••.........• - ---------- ------------------------ -------------------------------•---------------------------- `.. ......................... - ---. ----------------------------------------------------- ----- --------- Final Inspection by: ............Date _.� ..... .......... ................. s SAN JOAQUIN LOCAL HEALTH DISTRICT' E.H. 9 1-'68 Rev. 5M �^