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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /D � No. . Permit ... 10,-` - - "' (Complete In Triplicate) Dare Issued ....... __. ... _. ......_.............. This Permit Expires 1 Year From Dote Issued alth all the work described. Thishereb madeion ito the Sin Joaquin Localin with CountytOrd Orrict dinance permit and existing Rules tand Regulationherein q oo .lgr....CENSUS TRACT .......................... JOB ADDRESS/LOCATION [.D ice�Q.. .'. 9M-.-...W. 'r se,v,�� _ ...............................Phone . . �.:'�7+s./� Owner's Name (:.1.9.a.Fc.ei.Ct-._-....K.DLO-S-..IC.B.F ........................ Address _.. ..... .................._..._..._..._...__.......-...City ................._................................................ ......... n ........ Phone .. .. Contractor's Nome .._ .s�.t.C.flQetS ... .'SONrF...r K.C+.........License tY ................ Installation will serve: Residence KAportment House[] Commercial []Trailer Court ❑ Motel ❑Other ........ . ........Garbo a Grinder ............ Lot Size 1Sv.. ...1 .............. Number of living units:.. Number of bedrooms?/ 9 Private 41 Water Supply: Public System and name ....................... . . . Character of soil to a depth of 3 feet: Sand 0 Silt[IClay ❑ Peot Q Sandy Loam ❑ Clay Loam' Hardpan❑ Adobe Q Fill Material ............ I yes,type........................ ... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.l NEW INSTALLATION: (No septic tank or seepage pit permitted if Public sewer is available within 200 feet,l PACKAGE TREATMENT ( ] SEPTIC TANKI( ] Size........................................ . . Liquid Depth .....4.................... Capacity ......_ ........... Type _..._. ........... Material...................... No. Compartments ...................... Distance to nearest: Well ............... . . . ...........Foundation ...................... Prop. Line .................... . . Length of each line Total Length ............................ LEACHING LINE [ ) No. of Lines ""�- �"""'"�""��"" ............ ....... .. 'D' Box .. Type Filter Material Depth Filter Material ............................................ Foundation Property Line ........................ . Distance !o nearest: Well ........._.. ._....... �-� ��---- Diametec Number _........_......-....... Rock Filled Yes 0 No O SEEPAGE PIT [ ) Depth ��-��""�� ' Water Table Depth ............ .. .......... .. . . ............Rock Size ................ . . Distance to nearest: Well ....__. ...__.... ................Foundation .................... Prop. Line ........._........... ...__.................__ Date ..................................1 REPAIR/ADDITION(Prey. Sanitation Permit# ........ ._ , Septic Tank (Specify k .,uirementsl ..... — ' ^ � e - 7 " Disposal Fi Ido ISpeei(Y Re uq vements) ...... ........... i ......... . . . ..... (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 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, 1 shall not employ any person in such manner as to be5ome subjee ,oar m /p[> ComPansation la of aliforniaJ' Signed ♦ By _ .. (If4her than ow� FOR DEPARTMENT USE ONLY _ —..t_m� ....... DATE �,l T 1. APPLICATION ACCEPTED BY ..��.`'�' crr�� - - - - ---- �-- -� - y � - BUILDING PERMIT ISSUED __. ......_... . - -- - - ----- - .. - ..DATE ... .... ADDITIONAL COMM'NTS - - - - - - ` - -" "- --- _.. ..... .......__ . . .. ._. ... ._............ .. ............. . ......... J ..- Date Final Mspection by:;C 1-=�•� SAN JOAQUIN LOCAL HEALTH DISTRICT jibih, �r - i/723N E.H.L3 24 1--68 Rev. _iM