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{ .� _,a._ ��. vrr�t,t vat:- • - ., _.. _� ...�._._... .-,�,�...��.. _�a..�..�a.�.....,,.,�..�. �W---• .�._�_ ..w�....�,. �.-'.-1111 ,-•,�- _....�.m.... .. _ IS- 141,1 1111FO ( 'APPEICATION R SANITATION (Complete In Triplicate) Permit No. ......... ......................................•.................. This Permit Expires I Year From Date Issued Date Issued ..�"?V { 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 compliance with County Ordinance No. 549 and existing Rules and Regulationst JOB ADDRESS/LOCATION.. CENSUS TRACT ... Owner's Name r........ Phone Address .......City , =�-zc -. . • �- - �•. -- ... 1111. 1111 . .. ....... Contractor's Name ....lr� ;�.��..../� , • . c. f....-:__. .�............. •.4icense#!t...<. ...... Phone Installation will serve: Residence 0 Apartment House[] Commercial QTrallw Court [3 Motel j]Other............................................ Number of living units:.. Number of bedrooms ...I....Garbage Grinder Lot Size ............-`--Z•,••-............. k Water Supply. Public System and name Private 0- Character of soil to a depth of 3 feet: Sand o Silt O Clay (-] peat o Sandy Loam (] lay Cloam Q-- - Q 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 `' �.. ) ) SEPTIC TAMC{/I Size.,1>....r(.1..c...:�:.....�..:...---1111. Liquid Depth ...`.f.................. Capacity j-4-. :..0-------- Type `"``-,�... Material.__. �-<�. No. Compartments .' ..... Distance to nearest: Well ............5:[..�t...........Foundation ..... Prop. Line_.�.,f�......... LEACHING LINE &J No. of Lines _... ..... Length of each line..... .. ...... Total Length ...�. .�../.: .. 'D' Box .....!..... Type Filter Material ......S/Z .....-Depth Filter Material ....j,�..:............. Distance to nearest.. Well �:.' Foundations._ a'- �j . ....... ... (..::..�;. .... Property sine .........1`............ f SEEPk6E f'tT {r" Depth .......f.si._ ',{ .!Number . Rock Filled Yes { No Water Table Depth .................' --I- P Zt...-•-�-••--•-----•-•--......Rock Size __._./.�...................... // Distance to nearest: Well �,-.'—7!5, . :. .._..Foundation Prop. Line ... . ..... REPAIR/ADDITION(Prev. Sanitation Permit# .._......................................... Date ..................................I SepticTank (Specify Requirements) ..........................•--.---•--------..........._._.....------•-••---•------.......................-----.1111_... _ .........__._. Disposal Field (Specify Requirements) ....................................-..................................... --------------- 1111 ................................................... ----------......................•••....-............................................................................................ (Draw existing and required addition on reverse sidel I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, Slate laws, and Rules and Regulations of the San Joaquin Local Health Dlstridt. 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 ._........ ....... i y _ Owner lit ��..'. �'$y . ... . ..... ...... 111... ....... ..........other than owner - 11FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... :._. .. � ;............ DATE �.-.} ... BUILDING PERMIT ISSUED . ................................................•--..--------------.. . ....... .. ......DATE . .......................... 1111.. ADDITION Ai. COMMENTS ........... ..................................... .. ...................11 ..11....... ....._._............_..................... ......... ............. ....................... _ . ....- ---•-----•----•---•.........................1111.---1111.--- -......_.,�....... _.. ....... Final Inspection by: ......... ._.-_.C. ._::' --- --------------------------------............... ..-..- ......Date ....7. ................... . ... Eli 13 21t 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M