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r"" wrr"` "J`• APPLICATION FOR SANITATION PERMIT ............... . . . . ....Y-t-- ¢-------•-••- Permit . ... l- f , O (Complete in Triplicate), sued ,7 A ........................... This Permit Expires 1 Year From Dal*Issued Date Issued ./. -.Y.. 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 modsin compliance with County _ Orddiinane No. 549 and existing Rules and Regulotionsr JOB ADDRESS/L� J/.._... / J --..�. _404 LFa�. t. 6�............CENSUS TRACT .......................... Owner's Name ..-. .. ..t'!Ae r .....W.. r...............Phone ................................ Address .__...._.__......._ ^'3 Asti...........City . �7 �o ....... . ................... . Contractor's Name ..... 1:D....P&II ------.. {�yl tt{ ....{�ScT...........License# :F... Phone Installation will serve: Residence[�artmeM House❑ Commercial❑Trailer Court E] Number of living units---------f.. Number of s. age Grinder?-... Lot Size �da--•-kP�7.-f.......... Water Supply: Public System and name ..... s�'�� ate ❑ Character of soil to a depth of 3 feet: Sand o Silt❑ Gay Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ Adobe ill Material If yes, type ............... ............ N (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse sid NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size.............................-...............- . Liquid Depth _._..................... Capacity ----------------- Type ---- _------------ Material-----------..... ----- No. Compartments -----m........._..T�„ 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 Material ..... . .................................... Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ -- SEEPAGE PIT [ J Depth .................... Diameter ................ Number .....__.............----- Rock Filled Yes ❑ No Q Water Table Depth ---------------------------------------------Rock Size ....................__.._.... Distance to nearest: Welt ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........................................... Date ..................................I Septic Tank (Specify Requirements) --------------_--- ..... / . ..... ._.........................-.,.------.._................. Disposal Field (Specify Requirements) - L�?L 4�....... !{ a refs .. •.......... '- a .. --------......-------------------...--------------------------------------------------......-------------------•--------- -------. -M........ ..... .. -- --- ------------------------- - - --- - -........... .............................. .............. (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 Ilcen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, 1 shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." .. Signed -- - - ............. .. .. Owner By Title ... ... _- .. 7 - -... ... I other than owner) ----- - -- DEPARTMENT USE ONLY APPLI TION ACCEPTED BY. . .... .. . ............................................................. ............. DATE ...7.'T C. /..... ......- - BUILDING PERMIT ISSUED .. .... - . .. -- ....................................................................DATE .:.-:::---- ...... ....................- ATI(�NAL COM .................•--.............................................. - ............... .......................... 1. .-I.. ... .........................M................... --.............. ........................................... ................................ Final Inspection by: ... ..................M.. . .. ............... ..... . ...... � --------------- Mi 13 24 1-68 JO IN LOCAL HEALTH DISTRICT 874 3M