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#f'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 773 :........-..........._.......................... Permit No. ....._..-.--6?. (Complete in Triplicate) _._ ................. .......................... IL C �. This Permit Exp ires 1 Year from Dote IssuE I d •._._._ ._.7_ •-• Application is hereby made to the San Joaquin loco] Wealth District for a permit to construct and instoll the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N .L..7�,� '�....... . .............................................CENSUS TRACT ..........._.......__.._.. Owner's Name .. _......, ..., __ .� .. _._ ,_ . .. ....----••- --....__ .. ,--•. ........ .. ... hone .................................... w Address ............... t...�.l. ....... .. City p._.... .:..................... ....... ....... Contractor's Name _..,_ .�G +-f!�._ ,#100.3 ' . Phone `� !'"" License ............................. Installation will serve: Residence ❑Apartment House 0 Commercial❑Trailer Court Motel ❑Other ...... ..........:........ Number of living units,,--,,....... Number of bedrooms ............Garbage Grinder ............ Lot Size ...... Water Supply: Public System and name .........................................................._......._.._.... ......_......................Private Character of soil to a depth of 3 feet: Sand❑/Ut❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [n Adobe.[] Fill Material ............ If yes,type ...............1............ (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 lank orsee 'ge pit permitted if nublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Sixe--r�. e�:..,!�.�1.�...---�-•�--- Liquid Depth Capacity 4!tl... , Type . Material--- .+ ,___ No. Compartments ...................... Distance to neo st: Well ........... .o a_ _--•-........Foundation .....`f _.__.. .... Prop. Line .... .............. LEACHING LINE [�No. of Lines ............... Length of each --------- Total Length AeU...................,,J 'D' Box _. ... Type Filter Material .-__.-r_ ,.___Depth Niter Material ......e�lr'.�� ........................ N S Distance to nearest: Well ...... f? ........ Foundation ....fes?_'._._.____ Property Line .r3.�100- ........ SEEPAGE PIT [ Depth .... ...�..... Diameter ...�3��.. .Number ..........I.............. Rock Filled Yes Qj-_'No Q Water Table Depth / " ]tack Size � � X3 r p -•------------- ---•-- - -- •----- ......... Distance to nearest: Well . , Foundation Prop. Line -� REPAIR/ADDITION(Prev. Sanitation'Permit# _....._......................._ _.... .. Date _.___..._.._.._........._._____--.) Septic Tank (Specify Requirements) ........_.- ........- ............. -•--•--....__. ....._.._.......•--•-•- Disposal Field (Specify Requirements) ....................................................... ........ ._....-•-•------•--•.......-•-•................................................. ----------------------•--.._..................................... ........................DQ .......................................................I..........._._....- -•---••-...q.. ...----------------.................................................._..•-----------•--............... OQ [Draw existingand 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. dome owner or liven. 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 ........................................ .... r............:_.. Owner By ....._.._.................••--•------............ ( Title ..__ . .......... - (If other than owner) --------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ,7,2.o _....._..---••--------------•-•-•••••--............. ..._...... BUILDING PERMIT ISSUED......... ........ DATE .--- -•-............................•------•_--- ADDITIONAL COMMENTS ...: 8t ................I......... •--•-------•--...... .........,,//.. Final inspection by: = ------...................... .....---------- _.-.......................... ..----•---.._...---••--•-•...............................................................Date .... . .�:Q,I,7�...._...._. - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M