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FOR ..o: APPLICATION FOR SANITATION PERMIT i ...:................................................ Permit No. �7-�3,1`(Complete to Triplicate) ..................... .........................................•_-......_....... This Permit Expires 1 Year fret" Date Issued 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.,509 and existing Rules and Regulations: JOB ADDRESS/L AA ON(�-..._._._2.... r -...... NSUS TRACT .......................... Owner's Name 7� �"1 „ x'11 ; JJss�� r o L>Q ` Address �9 /� X,t /� d� . .. .. city _ ...1... ... ! ...................... i Contractor's Name _� -------------•-----•-----...-------- ............License # ....... -------------- Phone -------------------------- Installation will serve: Residence M Apartment House 0 Commercial❑Trailer Court 0 Motel ❑Other Number of living units:_..___-_-_ Number of bedrooms __-2..... Grinder Lot Size 19e' Water Supply: Public System and nameC _.Private❑- . ....................................._......._-------------------------------------- Character of soil to a depth of 3 feet:• Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam 0 Clay Loam ❑ �(\ 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 I ] SEPTIC TANK I ] Size------------------------------------- ---------- Liquid Depth .-_.--.---_--..--....... Capacity/�Oofiee Type -_---...__---�;. Material._._...-•_-- I�Io. �m artmenft 'Z..r._:.._. p ... • Distance to nearest: Well _.&0.......................Foundation __./Q.-........... Prop. Line .. ..:. LEACHING LINE [ ] No. of Linesii.... ............. Length ofeach�� line-.--.__.-- . Total length .�.�. .� ...... YAM .4P 'D' Box .... Type Filter Material Depth Filte�.Materiol ....... ....................f.... Distance to nearest: Well _ � --------- Foundation Foundation Zd..__•----------. Property Line ..�.1-6............ SEEPAGE PIT ( l Depth ---------------_-- Diameter .......... Number ................•--._.------ Rock Filled Yes ❑ No Cl WaterTable Depth ................................................Rock Size ................................ Distance to nearest. Well ._.....-----•---•---.•..................Foundat€on .................... Prop. Line .._.------.-......._.. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ------------_-------- Date ........_...__-----------..._-_.) SepticTank (Specify Requirements} r............---------------------•-------........................................._..............................--------................. Disposal Field (Specify Requirements) ---•------ •---------------------------------------- --------------- ..,... ... :.--------_------•-------...... ................................ •-----•--- (Draw existing and required add€tlon on reverse side) I hereby certify that J 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-flistrict. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of.4.0work for which this permit is issued, I shall not employ any person In such manner as to beco a ubj t to We j#kman's mpens ion laws of California." Signed ._ - - Owner - --------- - BY -----2-------------------------------....---------------------------------------------------------.---- Title ....-----------------------..............-.............................. (If other than owner) FOP iA ENT USE.4DNLY APPLICATION ACCEPTED BY -. - ------ -- - --•- •. • ......................................... DATE , ._..."7 BUILDING PERMIT ISSUED . •. ..._._DATE ---•--•......_ ._ - ' ADDtTfONAL COMMENTS .:`. r . __... ., � � ------------- ------- .----•---- �.. •----------- --- -- ----.. Final-inspection by: 'may--�.._.... f t ........... .........•-•--._....._.._.Da€ •-------- 13 2 -6 v• 5k AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M }