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Ole— FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " Permit No. ................................................ (Complete in Triplicate) ' 7L ......................I.............I............... % Dote Issued —�3— .. ................. This Permit Expires ) Year From Dote Issued .................................. Application is hereby mode to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L T{ON - Y� c .o't- Ale•7 ..... . _. CENSUS TRACT ...... _..A, . hone Owner's Name / __ - ._..... City ._ - - ...... .. .. -- Address -rJ .(/ ` . . . _ / ,.. r p arE�` ...._. ... . license #3 7-6 T/ Phone dr;U.'..A. 7 Contractor's Nome •d.- /% Installation will serve: Residence Apartment House❑ Commercial (Trailer Court ❑ -��--- —Motel ❑ Other Number of living units: Number of bedrooms . .._.._.Garbage Grinder . ..-. . . Lot Size Water Supply: Public System and name .............................. . .............. . ' -........ ............................. Private j ' Character of soil to a depth of 3 feet. Sand❑ Silt ❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loom ❑ i • 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) J, PACKAGE TREATMENT ( 1 SEPTIC TANK 1 Size_./lo400 - -•-• •.... liquid Depth . ............._-'-..._. 6 Capacity Type d::JWL - Material ............ ..... . No. Compartmonts -Z................ Distonce to nearest: Well -........ .Founrlotion - /o...#......._,. Prop. line .,S---f............. _ p................... O 0 Total length gi � / LEACHING LINE O No of Lines 3 length of each line - r-�... .� 'D' Box a✓ Type Filter Material AC .. ..-.-.Depth Filter MaterioL?V/ . A-"- -•••••-•--•••.. p . 1 i Distance.fo nearest: !5 Well /OQ..-_ _ Foundation �Qf Property Line 1r.f"•.�•......... {>ffpfc@!'-ptT ( ( Depth'yX�l#-- r -Number 3 _. Rock Filled Yes . No Q J _--.... Water Table Depth ._.-.-....Rock Size ---__ . ......... Distance to nearest: Well ...f..#G .. - -. -••••Foundation /4.-o......... Prop. Line .S.+f....'.---• REPAIR/ADDIT{ON(Prey. Sanitation PermitAw ...,.q... ...... � Date ................... ) ` Septic Tank (Specify Regvirements) ®v• . ........... ......... ........ ..............:`.... P. t �— .................................................. ......... Disposal Field (Specify Requirements) p.+ v- / y _ .j (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 aciord once 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: r "I certify that in the performance of the work for which this permit i�Issued, { shall not employ any.pers•on in ru 1t manner as to become object to Workprgn's Compensation laws of Colifomia." t Signed - ..... Owner •y +� By ...--....... ... .».. ...... . ............. . ............ ... Title `.. =t ""':.. L`�'=Ga._•.f�.•...� (If other than owner) FO EP�AR�T�MENT USE ONLY _ ._._r.... APP CATION`ACCEPTED BY (/ 0 4.....a.�.�..... ... .�` D ..?/�T ... .. .............. \. �. BUILDING PERMIT ISSUED `.•.. ....... . ......... _ ��istrt� ). DATE . - . ADDITIONAL COMIOENTS O,p+r�y° cA/I �.. rEGjtA,.r` fjiis ....... s �'r""y° .� � �►� OfIcG �atva :. ........ .r 44, ..eglowti:..XVAl/ic Dote .7! y/ �..................... Final Inspection by: ...................:.......... SAN JOAOUIN LOCAL HEALTH DISTRICT l _.. 7172 3 X