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FOR CIMCE USE: APPLICATION FOR SANITATION PERMIT ........ ...........:........_-•-•-- .......... . � q iDate Issued ........... This Permit Expires I Year From Dote Issued -D'L- Application"es hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein �5 described. Tliis,applicatiori-is made in compliance with County Ordinance No. 549 and existing Rules and Regulations - JOB ADflRESS/LO�ATIC}tJ �. ' (°� � � r Z*f�C��.G _v W,. CENSUS TRACT ............ Owner's Narrie �%... '`-�+' - � Phone •...».-._....__ ................ Address . 5 D... _�y� - oe- —14- ��tti - / .._........ - ......._- City ---------------- ......»......... ........_......_ Contractors Horne L�/�.x.cer✓..P�.• r f Y License # /Xe73 Phone ............. --�_ t ' Installation will serve: Residence ❑ Apartment Ho eC Commercial ETraiier Court [,l I Motel r' Other ...t.=►'rr�-...�-.�� Number of I ving units:.. Number of bedrooms ............Garbage Grinder ............ Lot Size ... ....................... ._.- 1^Dater Supply: Public System and Home ...------.--------------------------- di] F1_.........,...._.-_---- --.-----.__.........._. Private Character of soil to a depth of 3 feet: SanSilt ` Clay ❑ Peat E]Sandy Loam � Clay Loom "7 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.) NEW INSTALLATION: INo septic tank or seepage pit permitted -if public'sewer is available within 200 feet,! PACKAGE TREATMENT f] SEPTIC TANK [ ] Size ' :...� --------------___............ Liquid Depth Capacity Type .-...._...... _ { Material No. Compartments Distance toJ nearest: Well '.......- . Foundation -_-..--_........... Prop. Line ..........�..__..-..-. I LEACHING LINE [ ] No. of Lines ....... Length of each line , ...... Total Length ............ 'D' Box ..-- .-.... Type Filter Material' ......., Depth Filter Material .................. ..........,............... 4 1 , Distance to nearest: Well Foundation Property Line { SEEPAGE PIT f J Depth __..... Diameter ... .-..._.. Number' _- __-. - _ -_ Rock Filled Yes ❑ No ❑ tWater Table Depth ............... .......... .....__.._....-.Rock Size ............................ Distance to nearest: Well....................»..»»......._.:Foundatiort .................... Prop. Line ...................... l REPAIR /ADDITION (Prev, Sanitation Permit #.............. .............._ -Date .......... ..... ........ .,.... ..) Septic Tank (Specify Requirements) .......... .. ...................... ....... - - / ........_....._..___..._ I Disposal Feld (Specify Requirements) ........---... ._... _ ....... .So � -i� ..,� J� -z... . .................. .._. ........................ ..._... ............ _. ................ ... .......... 11 ............ .... ................. -- (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 Son Joaquin Local Health District. Home owner or licen. sed agents signature certifies the following: ' "I certifythat 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 .... .........•• ,y - .. itle. �'�nrz., ......... (!f other than owner] t ( _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY u'C..�J'-- - ---.. .. .. ...,.».__._..._.._.__._._ ., DATE ..,.r.a" ................ ..M BUILDING PERMIT ISSUED ................ .............. ADDITIONAL COMMENTS...................-................................ .. ........ _.._.......,._......::::...._.___- -:::: �:-: ~ ......::::: :::::::: .::::: - .:::::::::._._ :::.-................� , Final Inspection by, L •-�t.�_.. �. ._- --------•--...... - - —......... ..........Date ............................ .. .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M.