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FOR C]FACE USE: PPLICATION FOR SANITATION PEAT '/ (Complete in Triplicate) Permit No/( � .............................................. This Permit Expires 1 Year From Dato Issued Date Issued P7/X_11 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 . - lb7 gL /ffl/�l..�t�..- _ _ _ _ CENSUS TRACT .. ............ Owner's Name M _..Co T1.,!:�W.--- ----: .. . . --. -- .... ..- .....Phone -,, 2 -qts , AddressL7�.. ..... City (� ............. .. ................... Contractor's Name _ _/. .-_._ - . _.....License Co�5_�o2.... Phone,7 1l.��r�G-.-.. Installation will serve: Residence NJ Apartment House Commercial []Trailer Court � Motel ❑Other . - .. ._....................... Number of living units: Number of bedrooms . ......Garbage Grinder . -.. ._ Lot Size ...../... - ........................ Water Supply: Public System and name _ .&-1 y1�<an.....lug/.� ._.[�f.Si—.�..E. _..............Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loom ❑ Hardpan ❑ Adobe ❑ 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,) PACKAGE TREATMENT [ ) SEPTIC TANK I ] Size...............--------- _._ ...... -.. __ Liquid Depth ....._.. ................ _ Capacity Type ..- . . ---------- Material.._.._ ... No. Compartments ...................... Distance to nearest: Well . .. .... .................Foundation .-... ___._._... Prop. line ..................... J LEACHING LINE ( ] No. of Lines . Length of each line _ _ Total Length __ S 'D' Box Type Filter Material ......--------------Depth Filter Material ... __ _ _ .. ...... ._- Distance to nearest: Well .. _ ____....._.... Foundation _ _-..__._. Property Line -___.................3 SEEPAGE PIT [ ] Depth _ . Diameter ._._------. -- Number _ Rock Filled Yes ❑ No C) Water Table Depth _ __ _ .. ......-------------------------.-Rock Size ---_ Distance to nearest: Well _- .. ___......._.............._ .Foundation .......... . . __ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------- _. _. ... ..................... Date .................... _ ) q9 , r ` Septic Tank (Specify Requirements) /-t -C�--G_Al.---- ..=,r✓.. ....._... 11 �5_"............ _ _..... Disposal Field (Specify Requirements) ..._ ------------------- .. ......I-------------.-.._ ._.__._.._ .......... (Draw existing and required addition on reverse side) I hereby certify that 1 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. Home owner or licen. sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issved, I shall not employ any person in such manner as to become subject o.Yo man/n''' mpe�nsation laws of California." Signed . .-.r ...7�1CrCl.-L,/..-.. __ Owner By _. ..._. ....._-. - - Jitle (If other than owner) FOR DE ARTI ENT USE ONLY —APPLICATION ACCEPTED BY - DATE . ��7 9_ _ BUILDING PERMIT ISSUED _ ___ _.. _ -DATE ......... _. . . .... ADDITIONAL COMMENTS . _ .. _.. . ..- . ------------------- ....... .- . . _. -- .... .................... L .. - -- ----------------------------- .........- . . ..... - �/ Final Inspection by.' �e e _ ._.. . _ ._ Date - .. .' T..--.... ._ L SAN JOAQUIN LOCAL HEALTH DISTRICT c: u 13 24 1 •Ao e_.. eu