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FOR OFFICE USE. .). 11' APPLICATION FOR SANITATION PERMIT / _..__ .._.. _ __..t41 a•G Permit No. 4J:-31L- (Complete in Triplicate) y ~ _.. This Permit Expires 1 Year From Date Nsued Date Issued Application is hereby made to the Son Joaquin Local Health District for a permi! 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 CENSUS TRACT .............. .. Owner's Name �.0/(�Ct._r':.).� 1.,. 11.t Cj�L:u.r.1 .. . ._ ... .... ....... _ .. .__.Phone _ _. _ ..... ... . . .... Address . ...- , , � � . L - �✓ ... .- �,e- ne� ..Contractor's Nome C License / ' / Installation will serve: Residence❑Apartment House 7 Comrnxrcial L-41Tratter Court ❑ Motel ❑Other ___.... . . .. _......__ _._._.. Number of living units: .. .. Number a' bedrooms . .. .Gc wa;e Grinder __. Lot Size ;C f.c k,.._... ..... . -. Water Supply: Public System and name .. .. ... ...._ _ ........__. . . ... ... . ....... . .. ...... .......... ..Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy _ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ill 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 ;ewer is available within 200 feo-tJ PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size...., . ........ ._. Liquid Depth .. _. ._.... Capacity . — - . __— Type ._ .. . _ .. Material._ . _... No. Compartments .. . ..... V Distance to nearest: Well . ...___...._ ............. ...Foundation .. .__. ......... .. Prop. Line ...... ............... LEACHING LINE ( ] No. of Lines . . __ _ . .. Length of each line .. Total Length 'D' Box . .. . Type Filter Material ._ ................Depth Filter M.teriol ._._ —_.........._................_- Distance to nearest: Well ..... _. _ Foundation _. . . Property Line . .... ........ SEEPAGE PIT [ ] Depth _ Diameter .__. Numbe• _. Rock Filled Yes ❑ No 04 %'Voter Table Depth _ ..... ..... ... .. .........Rock Size __.. _........ Distance to nearest: Well ...... .._..__.. ...._..Foundation . ._ _. __._._ Prop. Line ..................._. REPAIR/ADDITION(Prev. Sanitation Permit# ..-..... . .. __. ... _ Date .._ _.._. . .__............. I Septic Tank (Specify Requirements) .. . _ __ ... r / Disposy�r Field (specify Requirement-) ........ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the won: will be done in accordance with San Joaquin County Ordinances, State Laws, and Pales and Regulations of the Son Joaquin Local Health District. Home ovener or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which :his permit is %rived I shall not employ any person in such mnnner as to become subject to Workman's Compensation laws of Californio." S yrec: _.. . Owr✓ Yrie Ilf other tho-J vm I L - FOR DEPARTMENT USE ONLY -_PPLICATION ACCEPTED EY s/' -/%. G/v- DOTE —�-C%•. 3J,-DING PERMIT ISSUED DATE ,..::ITIONAL COMMENTS �` a lam-- SAN