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r�nc a�rrne uoe: r� APPLICATION FOR SANITATION PERMIT ................. _ ................................. 0 (Campieteln Triplicate) Permit No. .�.97;3 ..... ................. .... .......................... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work heroin described, This application Is made In compliance with County Ordinance No. 549 and existing Rules and Reguiationse JOB ADDRESS/L ....................... `................CENSUS TRA ....................... Owner's Mame6C, ..... . � fJ ........................ ................ Phone Address , .......... ...... . .. t:F:....... C...City .........�......,.�r....-- ......... Contractor's Name #�.�z.. ..f��.`�. Phone Installation will server Residence EYApartment House C3 Commensal❑Trailer Court ❑ Motel❑Other............................................ Number of living units:.. . Number of rooms .A.....Garbage Grinder .. �.':.. Lot Size ........ S Water Supply, Public System and name ..-. ._ ........( G ......_.........................................Private❑ Character of soil tact depth of 3 fast: Sand❑ Sllt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ Hardpan❑ Adobso 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 INSTALLATIONS (No septic tank or seepage pit pepnitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK �jS "118. .............•-•--.--•........................ Liquid Depth .......................... Capacity .................... Type ............•....... Material...................... No. Compartments ...................... Distance to nearest: Well. ....................................Foundation .................... Prop. Line ...................... LEACHING LINE No. of Lines ...../............. Length of ch line....a.� ...r......... Total Length ..r •.....•..•�j 'D' Box ..../.- Type Filter Materlal . ....Depth Filter Material `............. . .......... • , Distance to nearest: Well .Gil.. Foundation _ 47... ......... Property Line ..r....•....•. SEEPAGE PIT Depth � /.... Diameter a . �. Number ......Z...... .... Rock Filled Yes No ❑0 Water Table Depth ...l�I�....................................Rock Size _, . ... .. ......... Distance to nearest: Well .�Zi��.�' ....Foundation .. �. �.... Prop. Line ..`.� ....... REPAIR/ADDITION)Prov. Sanitation Permit# ............................................ Date ................ . ............_ .( 5 Septic Tank (Specify Requirements! ................ .7........................................ --- •.. ....... .. .............. Disposal Field fteci5 Requireme ts) .. ........ . ........ .... .......... r.. .............. 1..- ----. .. .. .. .. .f ....................... . .......................................................... .. .. ................................._... ............... Draw existing and required addition an reverse :;de) I hereby certify that 1 have prepared this application and that the work will he done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or Ilcete- sed agents signature certifies the followings "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 California." Signed ...................... Owner - . Title .. �ol-hrlhan-o�wner-)- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' DATE .... `.-`-1-•.. ! .............:-- .:........................ BUILDING PERMIT ISSUED .. HATE ........................................... .... -•--•---••••............ . ...................................................... ADDITIONAL COMMENTS .............................. ..I...................... ........ .............. ....................................................... Fina! Inspection by: .. .............I...............................Date ....e�`. -. � ......... EH 13 24 1-60 11ov. y?I AN lOAQUIN LOCAL HEALTH DISTRICT $/7h 3M