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FOR OFFICE USE: APPLICATION FOR. SANITATION PERMIT 3 Permit No. 6 S� (Complete lin Triplicatel . _ _ . I - Date Issued .............. ...............................................••-------• This Permit ExpiresI Year gone Datelsruod" 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/LOCAT N ......� ---•�",�•-�...._C...:-� �-,/� •• --•-• ..:..........CENSUS TRACT ....,............. ....... r Owner's Name ......./. �....._. ...........................................Phon ............:.•..................... Address .:. .... 7.� . s".!.Z.A/F0 '----------- city .../�i G' .. ... ....- /'� Contractor's Name ---t�- �. �c.� �clC?......License # ..s f. Phone -ji Installation will serve: Residence [Ylpartrnent House Commercial❑Trailer Court 0 Akotel ❑`Other_-.-.-•-_----- ..... ................... Number of living units:...I....... Number of bedrooms ....- ___._Garbage Grinder .......-,... Lot Size 'Water Supply: Public System and name i .......Private ,j•, Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam I❑ 1-Clay Loony ❑ Hardpan ❑ „-Adobe PlI.Moterial ............ If yes,typo (Plot plan,, showing size of lot, location of sys :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,l I PACKAGE,TREATMENT ( I SEPTICTANKIII Size.--.._-- -r ---------------- -- -- Liquid Depth ................. ....... x Caipacity ...-----•._..._ T—yPe ------------:r---- Mate:rial- -------------•...r..._ No. Compartments F,r ' fs Distance to nearest: _Weis ----------- Foundation on ................ P Prop. .:._..... . ----__---•-- - V �` --- of each.,lie L-- 41.0---.... Total Length ._..._. •0........•-. LEACHING LINE No. of Lines ©' Box � LDepth filter Mtterialfi h - Distance to nearest: Welif_ � -_.. '-•••• foundation ...--./-Q.-...-�'--=—Property Line . ,. NuM6er ..._...../................. Dock Filled Yes No i❑ SEEPAGE PIT [ � Depth __:: ..__ D•ig?netBr __ F r I Rock Size`' . _.,?l{J.�,- Water Table Depth -•---, -_ :A _�. Distance to nearest: Well ..___.._�: .f ..-I_.... 'Foundation ` .... Prop. Line --•. .-•-••••••••. ' RI:PAlR/ADDITION(Prev. Sanitation Permit# --_:-.--;.�------------------•---------- Date ...-�—=---===-•--:--==_===-••1 Septic Tank (Specify Requirements) . - ` Dis sal Fi Id ISpeciy Rerquire entsl r ` ..1 . ------ ----------- f _. .. - 3 , ----------- -- r ' �xi" an _---__-_•-_-,..._.......................................................................................•..... (Draw e uired 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 lice* sed agents signature certifies OWfollowiitg: "I certify that in the performance of tee-work for which this-perrnit pis Issued,"ll'sholl not employ any person In such manner as to I�eeo b;ed to Wa�mate's ompens ears laws of California." " Signed - r •-�_.. B -�1 ---••- ---= ------ Title By (lf other than ner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY __._ DATE .. `-a". '._..: ............. BUIiDING PERMIT ISSUED ------------ ------ •-- ---...DATE --------..................••............ ADDITIONAL_ COMMENTS ----------------------------------------------------------------------•-----------------------------------------------------------------......---------------- - ---- ...- _._. -------------- - -`-------,.E_...--.----......................-..--------- --------------- ------------------•-•.._..� ..�. _ .�...:........._... I final Inspection by: ..................... Date EH 13 .2} 1=68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M �t t