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FOR OFFICE USE: I APPLICATION FOR SANITATION 1=UI�0T r i Permit No. .c.. ......lQ.... (Complete in Triplicate) �N1111111, ....... This Permit Expires 1 Year From Date Issued Dote Issued ✓...-c .�....�c' Appiicaiion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein descrihej Tha oppiication is mode ;n compliance with County Ordinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCAT(ON . .1.. ..L L?. - . l.yl....... L(/.V.. ..L. �... .. _any t2ENSUS TRACT ......... ............... Ovmer's ^!ame )_ . .......... . ....Phone ................_................. „ddress .. _._ .._. . -� .I �.. .i. �7....... .... ......City ..... . ... ... . . _............ ............... Ccn!roctar's Name . . a�,. ` L% 'l� ... . PJI_.License # .DD.3iY...... Phone ............ ................. Installation will serve: Residence;1�artmo,,t Hdu'se❑ Commercial ❑Trailer Court ❑ Motel ❑Other ......... ............... Number of living units: .....? Number of bedrooms ._......Garbage Grinder .. ...... .. Lot Size ................................. .......... Water Supply: Public Svstem and name . ... . -------------__....... .................-.......................................Private Qom/ Chvracter of soil to a depth of 3 feet: Sand./S.J❑ Cioy 7 Peot❑ Sandy Loom ❑ Clay Loom ❑ .e� Pardpon❑ Adobe ❑ Fill Material ...... ..... if yes,type....................... .... (Plot plan, showing size cf lot, local on of systPrn in :elat,on to wells, buildings, etc. must be placed onreve� r� se side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feel,) PACKAGE TREATMENT ] SEPTIC TANK[ ] Size....... ................ ... ......... ........ Liqui? Uepth .......................... t\ Capacity :.... Type ......... .......... Material.. ....... _ ....... No. Compartments ...................... N Distance to nearest: Well .................. ................ .... ................ Prop. Line...................... LEACHING LINE [ J No. of Lines _ ..._ ._ Leng'h of each line ....__ ......... ...... Total Leigtf, ............................ 'D' Box .... Type Filter Material ....................Depth Filter Material ....... .................................... Distance to nearest: Well . -..... .............. Foundation _ . ....... ......... Property Line ........................ SEEPAGE PIT O Depth . _. . .. . Diameter .. . ..... .... Numbe- . . . . ............ .... Rock Filled Yes ❑ No Water Table Depth .. ...... ........ .... .......................Rock Sire ............................... Distance to nearest: Well . . ........ .........................Foundation . .................. Prop. Line ......................� REPAIR/ADDITION(Prev. Sanitation Permit# ........ .. ... ...... ............... ... Date .. ...............................I Septic Tank (Specify Requirements) . . ..........................--.----*- --.__...----- ..._..._ Disposal '!f iS ec' Re vire ent -etiGcr C. i... -rr-................. p i P Y q - .... ......... 43. _.��.C�........ /C .1 ......._........... .........I.... .....O...r....... v................................... _ .. _. .. . ..__ .. (brow existinc,• and required addition on reverse side) s I hereby certify that I hove 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, I shelf not employ any person: in such mariner as to become subject to W 1t Compensation ws of California." J fined —C ... ... Owner _( ... .7......... 8y � Yts o f �'r. v.l.d qg— Title --J, -( f7.. .._........ ............. (If oth�than owner) / FOR DEPARTMENT USE ONLY - ----- -=---