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FOR OFFICE USE: -- PPLICATION FOR SANITATION PEk,-.,,T �(Complete in Triplicate) Permit No- - --7-- ------- - ...... ........ This Permit Expires i Year From Date Issued Date Issued �- -7.....� 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 compl'ance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/Lal/O N ...��7. .- / r.. . �.. CENSUS TRACT ..... J._... Owner's Name L - r/ rAddress . . " ...-/0 4= � (e City � - .__.:_. -----.-•............................ f s. . ..----- ........ - s 3 Contractor's Name - --. -- ---- .License # Phone . ..... _� .: Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court f /� 'c x 5{ Motel C1 Other .. r � =�' ----- Number of living units:.. ... Number of bedrooms ____5 ____Garbage Grinder ------- -. Lot Size ............. Water Supply: Public System and name ___.-_ g''`-- _ t�.rY,r_:et --__y > �_ Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Qn Sandy Loam ❑ Clay Loam ❑ �`\ Hardpan ❑ Adobe ❑ 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.) r• NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size..............................................-- Liquid Depth .......................... l� Capacity - ...-----. Type ------------------ Material------- ------------- No. Compartments -----------•-•-------- - Distance to nearest: Well --------------------------•---------Foundation -.----------------- Prop. Line ...........----------- � ) g ----.--.... Total Length LEACHING LINT: No. of Lines ------------------------ Length of each line.-------.-.-.-. - -----,---------------------, t 'D' Box .._ . ...... Type Filter Material ......•-------------Depth Filter Material _.-.--..--------------------I—------------ ti Distance to nearest: Well ------------------------ Foundation ---- ------------------- Property line ___-__..__..-_-_---____- ;± SEEPAGE PIT [ ] Depth Diameter ________________ Number ........_.---_------ ----- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------------Rock Size ---------.---------------..----- -•----------------•_Foundation ---------- -- p Distance to nearest: Well ___________________ _ . --... Prop. Line __.._-____________._ REPAIR/ADDITION(Prev. Sanitation Permit# ----------_-------____-----------_---------- Date ----------------------------------I Septic Tank (Specify Requirements) - - isposol Field (Specify Requirements) __- --A - ------------�_ , 1` ---- ., ...----.. --- - �e d� 1+` - ........ .._ -.... - --------------- ------------------------------------------------------------------------------------------------------------------------••----------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 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, i shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ..... ---------------------- Owner By . --- --- -•................- •=z.{2` Cff c" 2_ Title c� Ct -------------- ------•--- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------- DATE -. `5-~`.7__....--...-_-----_. BUILDING PERMIT ISSUED - ---------------- --DATE ..................•----__-----------•--- ADDITIONAL COMMENTS ................ .......... ...............--....................-- ..l.En...s.pe. c..t..io...nby......:..... 14 Fina -- ---- -•----- --------- •-- •- -- ----------- •--.... ------------------ ---------------- --__ -- _ .c -c_.--_ Date _......_��s:.7. ._. ------------ SAN JOAQUIN LOCAL HEALTH DISTRICTQ