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FOR OFFICE USE: 1D.3 b APPLICATION FOR SANITATION PERMIT ,.... ...................".. .. ....._.... Permit Na. �,!-3 O �, (Complete in Triplicate) ....-"-.•........... ............ ......30...........----------....I....... `?�7X 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: J08 ADDRESS/IOCATION .:_,3_1.1.----SO,. fllly./I rl-,I C y----.�� .�: ; . c //TitAcT ..................:..:.... Owner's Nome ./ W. . ..--d�.X=4,eQX 1 r Pho# _ .=io ,j r Address .-f. /.., '.....%I-G�WIfE'!0.0...0-R,-_------••- ----------- . City -f lY�'L`�,��..............•---•---•................. � a Contractor's Name .. _ _ . ��'�'r..-.��: T/+ '...--5'��t.� T"r`.".license�#� ;73� --. Phone � `" �f.�. . Installation will serve: Residencea Apartment House❑ Commercial [3Trailer Court Motel []Offer .... ... ........................ r i Number of living units:"" ------- Number of bedrooms -,Z....Garl`age Grinder...1.x...0. Lot Size ...........:... Water Supply: Public and name t s Private ❑ pP Y _ F a ................ ......... . I . .._...__.__...._..........______.__.. ............_...._._P � to � I ZZ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay'[]�'I?ect_j ' Sandy,Loam ❑ Clay Loam ❑ Hard an Adobe Fill NlTiterial ._ ...._ If yes,type .............."-_--____-_- p ❑ (Plot pian, showing,.size of lot, location of system in relation oto dwells, buildings, etc. must be placed on reverse side. NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewgr_is_avoilgbie within 2,0O feet,j PACKAGE TREATMENT [ } SEPTIC TANKT ] Size,....`....... ................................ Liquid Depth ........................... Capacity �_-- Material.._.:________._-_--. No. Compartments ...-.................. Distance to nearest: Well ...........:. k -----------------------Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of lines ------------------------ Length of each line.-- ------.........._....... Total length , DBax Type Filter Material ' ' ._.Depth Filter Material Distance to nearest: Well ....................:... Foundation _-.__--------_--... Property Line ........................ SEEPAGE PIT [ ] Depth _..----------....... Diameter ...........`.... Number .L..................I.... Rock Filled Yes ❑ No Water Table Depth ...........Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit+# .............. pate j r Septic Tank (Specify Requirements) -•----- ------------- -------= .. ........................................_.._.. t Disposal Field JSpecify Requirements) -----------•-,1...................................................... - ------......-- `-..•-----•,------------------....._.._..------......--•-..............._.. (Draw existing and required addition on reverse side) I 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 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 Cailforn Signed ................................ Owner ----- . ..... ... ..-•---•-- - �,p 8Y ---------- ......................... ._. Title ��_Q._ _ (if other than caner) // FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - . ._ ..--•------------------------------------------•...------------------.-........•----_. DATE ....----....-----.... BUILDING PERMIT ISSUED •• .... .......................................... ----------- ---_--_-_---------_----...........DATE .......... :.. ADDITIONAL COMMENTS " = ..................................... . ----------------------------------•--------.._... ................................ ..Final Inspection by: ...:. ------.Date -t�.. . w........... SAN JOAQUIN LOCAL .HEALTH DISTRICT C �.� E. H.13 24 1-'b8 Rev. 5M 7172 3 M ,