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of ' Fke Usti: APPLICATION FOR SANITATIO?�t PERMITPermit � �. (Coietplete to Triplicate) �M , :............:............................ w1 ., . Ued _-- . Doti-Issued This Permit Expires 1 Year From ate lss ad •-�- i` 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: JOB ADDRESS/LOCATION . .�_�..S..L._..5-•- ..........CENSUS TRACT ,,,�` y./ Phone .Owner's Name ..c'!S�!!L. ,�n--..0�� - - •-•---- -----..,........---.........:............... ... . ................. .._......._. 3... Address .:.....:...... __...._ _ .._.f'::'r. _.........._. .....__.. ..Q _....... .. .a.,... • _ �_��.___._ .; �... % - --�.�.. _. - - �6. Phone .- Contractor's Li nse t4`- � installation will serve: Residence JdA ortment Housefl Comm tial OTialler Court P - Motel ❑Other . ----• - --------------•----------------- I r Number of iivirig units----!........ Number of bedrooms ...Garbage Grinder ... Lot Size ........ Water Supply: Pubtic System and name : Private _..---....------. ---•-•............................................................ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [J Peat(] Sandy Loam r] Clay Loam CJ l Hardpan❑ Adobe fl F41,doterial '....... If yes,type ....... .......... F (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 se r Is available within~ 200 feet,) L r,PACKAGE TREATMENT [ SEPTIC TANK t } Sizp--- 0--- . -----..Liquid Depth .......................... C .� Capacity ---------------- Type lQ)L .'Materia ... .....#' j No. .Camparfm nts .. 1 _ .� Distance.to nearest: Well JIM. .!_� foundation �i0...---- Prop. Line ...�...-_-... i �.. .._ _ Total Length .10.-�Bd........ LEACHING LINE [ ] No. of tines ....;5 Leng of each lin2-- - //pp91 --- �d Depth Filter Material !a.• 'D' Box`< - Filter Material 1 A- p ............ r Distance to nearest: Well ._ _._.._.... Foundation Jif -•---E....... Property Llne ... ......... . - .............. �Y SEEPAGE PIT [ J Depth -------------------• Diameter ................ Number .........a----_...._._.._.. Rock Filled Yes ❑ No i❑ k f r Water Table Depth ......................................Rock Size ............ ................... r -Distance.to-nearest: Well _:.:..- ....... ............Foundation-z-.___. •.-,....Prop.Aine .................7• REPAIR/ADDITION(Prev. Sanitation Permit# --------- , ------------- Date ............................. .__.) Septic.Tank (Specify Requirements) --•-------------------- --------•---- ........... ........................•----....................................................... Disposal Field (Specify Requirements) ........... .. .............. --------------------------------------------------------------:--------- ........................t_.... -------•-•- -•------------------ -------------------...-----------------------------------------._...------------------ ---------------................... . (Draw existing and 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 County Ordinances, State Laws; and Mules and Regulations of the Son Joaquin Local Health:District. Homeowner or Ilcen- sed agents signature certifies the following: I ~ "t certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." r --j.. --- • Owner Signed •---- I BY /F' �L -------------------•---•-•--•---------•--•-••----- Titl _.LO f� POW—- e f other t n owner) FPR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY _. .. _.... ----- DATE _. ..._. ._Z .... .. .;.------------ BUILDING PEWIT PERMIT ISSUED ------ ----------- --------------------- - - - DATE ._fit..._._._...__....._... ADDITIONAL COMMENTS -------'.-------•--.......... .......... ...... ........ ..............".._._........ -.........._..... - -------- -------------------- ---- ....... .................. --------- --- ------------- --- --•---------- -----/....... •-•-•-•. Final Inspection by: . �I ©ate ... Z. .. ..... .. ............ Ell 13 24 1--68 Ifev• 5M SAN JOAQUIff LOCAL HEALTH DISTRICT t /74 3M f