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FOR OFFICE USE: .._��. 'PPLICATION F.JR SANITATION PEP"' T _. ... .... . .................. .. _ Permit No. ....7T. .. (Complete in Triplicate) .......................................... ...._ ... .............................................. This Permit Expires 1 Year From Dara Issued Date Issued .......1. ...--.... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L7j.,.,)�7 ION _. ..- •-/--�._..... ....._.......... ---arr- -• ---..--- r4S._.......CENSUS TRACT .......................... Owner's Name . ik 1.�!✓ -!7 L1...-. .. Phone ........_.......................... �3r...... y ty . .. . .................. ...........Address ._......... _... ... jllgrpartmentjHouse - ........ ............. CI ._......... ... /../ Contractor's Name ._---17-L-6...... r pA... .. ... ............................License � h...... Phone 1� EfP Installation will serve: Residence0 Commercial OTrailer Court n Motel ❑Other .............. ............................ Number of living units:.....!.... Number of bedrooms,?....---.Garbage Grind erlyt J-.-- Lot Size ............................................ _ Water Supply: Public System and name ......-........................................_..-...:._._.�..................__..._.-----........_.-.Private [�}� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Q Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill MaterioW ..... 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,j �j �✓ •- PACKAGE TREATMENT [ ] SEPTIC TANK �ize.....'i�yx__X_ Liquid Depth ..� r rz.........� .. ........... Capacity .-� .-........ Type a�fQ-...-!i:?.f.Materia -..ph- .&a/A_. No. Compartments a� _1 _ Distance to nearest: Well ....�:........................Foundatlon ./q./........--. Prop. Line ... ..!.............. LEACHING LINE [ No. of Lines _ - ............ Length of each Iine.4/...�.5.......... Total Length ,1..�'d.!........... I D' Box ...1 __. Type Filter Material.—,� r.....Depih Filter Material ./6t--.�'---.--._..-_---------------lam Distance to nearest: Well ..�/.Gl ?._ ..... Foundation " ' Property Line WS.-..�......---.- SEEPAGE PIT (4-- Depth L-24 ....... Diameter -3 `..... Number .... _ Rods Filled Yes EP—M-0 ,3 !�. Water Table Depth ------6 .`1../...............................Rock Site ... y 1 � ....... Distance to nearest: Well .....ZeT.......................Foundation .....18:.x.... Prop. Line .......... REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ......................._......... ) Septic Tank (Specify Requirements) ........ . .......a........................... .. ........ .......5 -...-...._....---------- ------- .--- ........_................. Disposal Field (Specify Requirements) ... �a• `-�............................_..-------.---------------•------- - - - ........ .......... . .......... ---------__ r - ----- ---------------•------------------------------ - .................... ........ --•---------......----•------•................................ --- - -- ................ . ......... .. ..... ..........................•-•----....................•. ...... ------------•----------........•-------•-•-.........................---_.. (Draw existing and required addition on reverse side) 1 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 licen- sed agents signature certifies the following: "I certify that in the performance 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 .... ............... - Owner " By . ........ ........ . . . ...... ...... _!��/`7 ................................ Title .... ..... �. T . . . . (if of than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...._CoA --.. OAva�__...i... ........................... .......... DATE ---� ..g.. - - -----•............ BUILDING PERMIT ISSUED - ............ ...:.. ........ .......------.............................DATE ................................... ADDITIONALCOMMENTS ........................................ -.••----......._._................................. ------ .....................-......... ................. . . ......................_..------.._......................................... ., . ........----•-...:-............................. ...................................... �,j Final Inspection by -. - ....................................................... Date . .. ...1.................. t. SAN JOAQUIN LOCAL HEALTH DISTRICT F H 13 24 t.vaa oe„ FAA 7/77 3 M