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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit NoIK :...j� .••-• ............ ......................................... (Complete in Triplicate) .... .........................•- Date Issued .......... ........... .......��:.�.� .......... This Permit Expires 1 Year From Date Issued 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 Regulations: t p / JOB ADDRESS/LOCATION L ��-`'�_... idT C'J.S_4.e�+'......�f� 5......./7..G1.....................CENSUS TRACT ..................... Owner's Name ...... �1i111./�+. '1..�.. 4.Y.. .aa.��....w7?`............................. Phone . _. ....... ------ Owner's f s . Tr,4 c ...... .. ................ -••........-----..--- Address _..-�-�_llb�._.._.��.T.f%�at?��..,.. ....1!..s......_ �....... ............ Cih+ ---....... ..�.. _......._. �J �- /}.17License #1+� ff--6..... Phone ! :.y.t........ Contractor's Nome ..f'.�.. r1!. _XLS ��y.._.'F.StrN.. I Installation will serve: Residence 1K Apartment House❑ Commercial ❑Trailer Court ❑ IMotel ❑Other ............................................ Number of living units:.../....... Number of bedrooms ...4/.....Garbage Grinder ........ Lot tot Size ...............•••••••••. Water Supply: Public System and name .......•......... Private$J�- 3,_ r- - at _ _ Loam Clay Loom ,9 soil`to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Laam {] Y ...._ . . _ Ha dpan ❑ 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.) NEW INSTALLATION: (No septic t�nk or seepa pit permitted if public sewer is available within 200 feet, e , 9 PACKAGE TREATMENT [ ) SEPTIC TANK j Size..1`�t -------••............•----• Liquid Depth .... .�.��................ �. C ._A................ % Ca achy � .��?� Type�e•�'A.s.T.... Material.-Ca.�l'_._'------ Na. Compartments istance to nearest: Well ..�r �._..-----••••----• I Foundation _%.'* ... Prop. Line 3fl0............. ` Total Len th `��d`!Y.3_...... LEACHING LINE ( No. of Lines ..._...-. Length of each line........-_ ...-• S 'D' Box .. _..... Type f=ilter Material ......Depth Filter Material .. . .................. -•••---9 `� Property Line 4FT.............� Distance to,nearest: Well ...��'d..fi••••• Foundation .f �.._....... _ SEEPAGE PIT [ J Depth .......... ......... Diameter ................ Number ............................ Rock Filled Yes ❑ No Qty , Water Table Depth .....Rock Size ............ ................... f Distance to nearest: Well ........................................Foundation .................... Prop. line ---------_........... REPAIR/ADDITION(Prev. Sanitation Permit#�.............................. Date "' "'} 9 ...... `I .............. Septic Tank (Specify Requirement) ........................................... _........._...._. Disposal Field (Specify Requirements) _ _ .... . ... ... •---=-•. .... .. . . . . ....................._... . . . l •- --- - ------- -- _ ---- (Draw existing. . ..an. .d required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin y County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Horne owner or licen. ' sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shad not employ any person in such manner as to become subject to Workman's Compensation laws of California." i s Signed - 04V............................... Owner litIe _.. . .. .......... ..By .'----- { foer} .. FOR DEPARTMENT USE: ONLY - ----.....--•--... APPLICATION ACCEPTED:BY ...--...'! �' -'............... ........ ..•...........------..........._.........._.._....... DATE__........'�`.... ��4 BUILDING PERMIT ISSUED ::............ .... ........................................ . .............. DATE ......._.._. .........__..._.......__...... ADDITIONALCOMMENTS .. ...-•...........................•.. .. i......^...........I.................... . ......................._......._........................ �._.... .... ........... ..........: .. ......... :-•-- ...... ;.�t......_......_•-•-- ... . .... ----•........ •----............. ------------�>,- D ................................. I Final Inspection Ii -.. SAN JOAQUIN LOCAL HEALTH DISTRICT 111 '24. _ _ ._. _ i 7/72 3 M HYD"D.... SAA ^r""