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FOR OFFICE USE: V APPLICATIObi FOW SANITATION PERMIT ...--•............. Permit No. .. _.._ ...... {Complete in Triplicate) .%• - L� This Permit Expires 1 Year From Date Issued DateIssued 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/LOCATION ..�3-- ........... .......T .............. CENSUS TRACT .......................... . Owner's Name v *� T Phone .... 4�...... _.� 131,Com_-AF,97A.?" s................ � .�--. Address . ..........:......................... ............................... ..... City Contractor's Name .. , .. ........................_.--------------- ..License # - -- ........----.._.._. Phone ............................ 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 Character of soil to a depth of 3 feet: Sand❑ .....Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan-[j? 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,ar seepoge'pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ SEPTIC TANK-[ ] Size------------------------------------------------ Liquid Depth .......................... Capacity .. . { `YYIJe ..............: Material.---...--- .. ....--- No. Compartments ......................W Distance to nearest: Well ............Foundation ... .................. Prop. line ..................... 0 LEACHING LINE [ No. of Lines _ . .... ..... Length of each line ........................... Total C'erigth, ............................. 'D' Box ---.. Type Filter Material --------------------Depth-Filter Material".:l--- .................. Distance to nearest: Well ........................ Foundation ................... Property line ..................... SEEPAGE PIT [ ] Depth . .. _.. --------- Diameter ................ Number ..._._....... ... Rock Filled Yes ❑ No i❑ Water Table Depth ---------- -------•---.-•--• Rock-size =: ! `' - Distance to nearest: Well ....... f -- -----------•_••------•---•:--Founda ion ._._..... -...._.__ Prop. line ...................... REPAIR/ADDITION{Prev. Sanitation Permit# . 2 `rl. _1.-...___._.___..__ Date ' -_C�_ .___j Septic Tank {Specify Requirements) '------------------------------------ -------- ----- ...... ..................- ....,.:r. .._........_........._...., 1 I i Disposal Field (Specify Requirements) ..... `:.. ------- -------------------— . :.... . -- :_-:::. ..� Md Po �.1_sfi�4V_(9 Pc/S:/f. -.40...1.:.>^_ /.A+.-g... G-n X.. . ../ger.. .2`n �vT..... ....... f .. P...R._ (Draw existing and required addition on reverse side) herebycertifythat 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 licen- sed agents signature certifies the following: "i certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to becom subject to Workm is ompensation laws of California." I ��jj�� ................. Owner "'t. Signed:. ��C�i71�Pf. y.- By - ----- --------_...-----....---.._..----- --........_.. ----_.--.............. Title --- .... ..... .....- ............................. (If other than owner) .j FO EPARTMENT LISE i ONLY APPLICATION ACCEPTED BY .- I I DATE .... '` :` .... ............... BUILDING PERMIT ISSUED . ------ . ..................................... .. ..._DATE..... . ......:... ....... AQDITIONAL'COMMENTS . .... t 1 .. _ ....................---- •-•-------- ...... .......... .... .._ . ... ---....---- ........ _r"=:. , .......------..... ------ -•-- .:� _ ...-- -------•----•... .._. ----------- .-._..--•----- e I ................ ....................... . ....... .__ .. ------ .............r .....- -_...._...,. ,..%.s...... Final Inspection by: ....... . ---- _... . ----------------- � Date....-�.`�_-.7 ------------------ J QUIN LOCAL HEALTH DISTRICT �3 24 _ ;�,:;. <L72 3 �K . i-. -.I..H;. i-'6$ Rev. 5M ... 1