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FOR OFFICE USE: \.rPPLICATION FOR SANITATION PEh..,11 ermit No- .13. -n_-7.4 . . (Complete in Triplicate) This Permit Expires I Year From Date Issued Do e ' 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 comp/liaince with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...rll�lro .�F/iaI......... -)--CENSUS TRACT .......................... Owner's Name .....�1.!......4.k ..VZf� ............ .... '/..... ....Phone .................................... Address ....aS�10.4!r................... ............. ........................_......... City . /r�10*10:......................... ... .............. Contractor's Nome -------./ �C.�t..._:. ----------------------------License # rf./.1�:07�`�'.f. Phone ,�l�a` -•z�la�. Installation will serve: Residence❑Apartment House❑ Commercial XTrailer Court a Motel ❑Other ............................................ � Number of living units:..:..... Number of bedrooms ....'....Garbage Grinder !�/a Lot Size ..... ... .:............. Water Supply: Public System and name ............................... -.....-..................____...........................................Private 91 Character of soil to o depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe 0 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 [ J SEPTICTANK% Size..Cj�y .�' �.................... Liquid Depth x �_.__._......... Capacity/��.-.. Type ./' .:&....>. MateriolG6-?Zde.-A----- No. Compartments Distance to nearest: Well ......................Foundation . ......._.. Prop. Line./,��...»......... LEACHING LINE [Jd No. of Lines -----/--------------- Length of each line.Z4� Total Length /..1?c?.............. 'D' Box *e Type Filter Material ,L-- /ReDepth Filter Material t! ................................. Distance to nearest, Well ....... ....... Foundation ...94----- ------- Property Line /_/_, r............ SEEPAGE PIT J4 Depth ...4s ....... Diameter ... Number ......Z................. Rock Filled Yes pg No C3 Water Table Depth _..... .O.s` ...............................Rock Size Z. ...... i . Distance to nearest: Well .......././_.s.�e...................Foundation ...; ......... Prop. Line . 1'C?__.-_-._: REPAIRIADDITION(Prev. Sanitation Permit# ............................................ Date ..........__.......................I SepticTank (Specify Requirements) ....._......... ........-............ ...--------•-------------...--•-----............_-..............._......... ------•-_--_--- - Disposal Field (Specify Requirements) ----•-------•---------- n (Draw existing and 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. 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ......................... ................. ..---- .. Owner /may>� .........._. Title By ...__.........----... . ........Lr�G6!./.l . . ---..............-- ----------. . if er than owner) _ FOR DEPARTMENT, USE ONLY APPLICATION ACCEPTED BY ........... . .. . .•---------------..............--.....--------------------............. DATE .... �.z..�.�..---------- BUILDINGPERMIT ISSUED ............. -... •-•--•------.........•--....._..........0................ ------• ...--•--•--..DATE ..... ................................ ADDITIONALCOMMENTS .......................... ................................ ......................... -- -..-•---------.......------.......--------...---------.....--------- .. •- -- ... - - -- ..-.•.. -- .....- _..................... . . ... ....... .... �..- ...... .. .... . .. - .... D . Fina lnspectionby: ...........- - --•• .. . . .. . . ....................................... .. . ... --- .. ate �•- -N JOAQUIN LOCAL HEALTH DISTRICT