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APPLICATION FOR SANITATION PaMlyPermit No. ... (complete In TripllcaN Date Issue ••••••••••"""' %W las i tieser from Date Issued hefeln .. .'------ " . ' ' " ' This permltExp and Install the work ................................. permit to conttr Rules and Req ulotionse made to the San Joaquin Local Health District or o Rance with County Ordinance No. 549 and exlNing descri ation is hereby CENSUS TRACT """•• described. This application is mode in comp � rR� ........ . O .......e . .. . . hone JOB ADDRESS/LOCAT .z. .�3r �9./.(J.:......... ...........I.............. n, Owner's Name _.. ... e�17.....KL:.......City ..... .. . ..z. .. Address �7 a �j� � �.i..�....d� """""-.`..... . licenso *d^�.J..w!.�.7.J•..... Ph a . 1'§.�. 6�./...... Contractor's Name .............. .. Installation will serve: Residence o(Apartment House 0 Commercial ❑Traller Court Motel ❑Other ............................................ ........Garbage Grinder ............ Lot ....ze .......,,,,,•,,,,•Pri........... . N Number of living units:.....�..... Number of bedrooms fIVO � Water Supply: Public System and name ........................................................_................................ ... . Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay ❑ Feat� Sandy Loam ❑ Clay Loam Hardpan 0 Adobelp 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 [ 3 SEPTIC TANK[ 3 Size............................................a... Liquid Depth .......................... Capacity .................... Type .................... Material---................... No. Compartments ...................... Distance to nearost: Well ....................................Foundation ...................... Prop. Line ..................... [ LEACHING LINE _ ...... length of each line...._...................... Total length ty [ ) No. of lines . ..-... ............................ .J 'D' Box ... .._.... Type Filter Material ....................Depth Filter Material .............. .............................. Distance to nearest: Well ........................ Foundation -_. Property Line- - ........................ V) SEEPAGE PIT [ J Depth ......... Diameter Number "•�•'---••--•-- Rock Filled Yes ❑ No Q ............................ Water Table Depth ...... .........................................Rock Size ................ Distance to nearest: Well ............................... Foundation .................... Prop. Line ......................3 REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ............ ................ ... Disposal Field (Specify Requirements) Q ............p .................................................. ...................................................................................................................................... 9' _.... ..... 'ex' g.......*......... . ...................------................................... (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 liceo• 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 ................................ . .... r. . ..... Owner BY --- Jitle ..... ._ (If of er th wner 2 FO DEP MEN.. E ONLY APPLICATION ACCEPT D B _ _ BUILDING PERMIT ISSUED . DATE . ... . ... . _ ADDITIONAL COMMENTS ......._................................. .......... ..................DATE . _. . -......_...._.............. .... f.?.........................I................ ......... . .__. - .......................... ........................:.............. ...-. _...... .... Final Inspection b _.-- .... - .... .... ........... EH 13 2h 1-613 ..Itov. ....... . / ..... Date SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M