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FOIi,oFi+iCE iasis: APPLICATION FOR SANITATi ON PERM T 7s= 775'_ .3. .................. . .: IComplete in Triplicate! Permit No. . ........ ......................:-------- ............. 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 construct and install the work herein described. This application is made in compliance with aunty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ...... 1.`-- ..... _. ...r..... CENSUS TRACT ...................... .... ... Owner's Name ........ ...... ........ �./l!1;a/.L....................•----------.....- - • Phone .................................. Address . � .�.. ✓�.�� .• t ... City . � .......... ..... Contractor's Name .. --,r - ...-- License .-(/I/.. Phone Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ❑ Moteld Other ....... ........:............... .......... Number of living units /... Number of b rooms 3r. .....Garbaa Grinder Lot Size -.-,/ ?..-- -f ........... Water Supply: Public System and name ..... .�t�',� t!� Private ❑ i� Character of soil to a depth of,3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 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,) PACKAGE TREATMENT SEPTIC TANK- Size.. �' !� C { ] - �--��-•�.;��----..._..._ Liquid Depth .----•�................�' .1 Capo: ity�c (lfl. Xype Material... .. o. Compartments ..... -..-. Distance to nearest. Well foundation ....._.. Prop. Line �.P......... LEACHING LINE [ No. of Lines - Length of each line .-. . Total Length _.-�:./.�..�....... � �' 'D' Box ... Type Filter Material Depth- Filter Material -.-- f .......... ......• ' l ; �c / . Property Line ....�...... PIT Depth ....----. Diameter ��....-_-.FNumberon f �- --- .... P ty ......� ( Distance nearest: Well _ � !f ---- Rock Filled Yes [�' No SEEPAGE / �"� Water Table Depth .... f�.................... Rork Size ... .............. Distance to nearest: Well ---ko...(,4/ ........Foundation _-. ._ ----- Prop.Pro Line ..-Q................ REPAIR/ADDITION(Prev. Sanitation Permit# --------.---• . ---------------------------- Date ------------------_------- Septic -----------------_---Septic Tank (Specify Requirements) ........ -----------------------------------= --•---.......-- •............................. --------- .................... Disposal Field (Specify Requirements) ------------- ------------------- --------- ----_---- .................. . -- ......... ...................... ........... .. .... ........... -- --------- -- ------ ------------...........-..........—-------..........-- --.... -----•-• ----....-.--...--•---...._.. - (Drdw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will Oe done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 4 "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 By ...: - - . -. ... `dtKer than a Tirle caner) FR DEPA TMENT SE ONLY --7 APPLICATION ACCEPTED BY'....... DATE ... ............................... 4 BUILDINGPERMIT ISSUED ... ......... . _.................. .. ..... ....DATE . ......._ _.............. --- ........... ADDITIONAL COMMENTS .... ..................................................... ---------- .........:. .---------...................-........................ ...... ----------------------------------------------- Final Inspection by: -------- --- -- .. -- ------. ------------- --te _- � -------- .. t SAN JOAQUIN LOCAL 'HEALTH DISTRICT t -d' 7/ 2 F H 13 2 1.-AA 1tev. 5M 73 M . �..