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FOR OFFICE USE:. APPLICATION FOR SANITATION PERMIT - ---.......I.......-•---•----- •-••----------•-• . 7�'3 39 ;Conrpiet�In Triplicate) Permit o. .......... .......• .................:....................................... This Permit Expires 1 Year from Date Issued Date Issued .. ..... .......... Application is hereby made to the 'and In / �- ©/ San Joaquin Local Wealth District far a per #o construct and install the work herein - described. This applicdtfon,is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �,,,,.described. �fv fig.�. Coni� ,Q./J• ;::� _ .. JOB ADDRESS/LO TIONA' ft S+fENSUS TRACT GF .._ Owner's Name .. _• ............. ... --....--_. Phone p ----------------=•...__.._._...._•. Address .............. f>�j._v... ... -••.. _..... ...............,City ....4 / ............... License 30S 7---- _ Phone Contractor's Name .. � .. - - _ ."_,� .�-- _ �:�� Installation will serve: Residence U.Kportment Housefl 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 O Silt C 1 1 Clay o Peat❑ Sandy Loam"o Clay loam Hardpan[I Adobe 7 Fill Misterial ............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 lift permitted If public sewer is avalloble,within 200 feet,l . PACKAGE TREATMENT [ ] SEPTIC TANK ] Size................. :.................... Liquid Depth.....___..__..:...---....: m i - Capacity ------------- Type -------••--•--------- Material.------ ---••---•----- No. Compartments ............... Distance.';to nearest:`Well . -------- ...................Foundation ------------------•--- Prop. Line ............ LEACHING LINE [ j No. of Lines .......... �' i t Length of each line---------------------------- Total Length D' Bax Type Filter Mater#al Depth Filter Material Distance,to nearest: Well ........ ---..::,Foundation ........................ Property Line ......................... .... ' SEEPAGE PIT [ ! Depth .- ---- Diameter ________________ Number .........._ ................ Rock Filled Yes ❑ No 0-- Water rWater Table Depth ..............................................:.Rock Size .....-•-----.-__ ......... Distance to nearest: Well ...Foundation ____________________ Prop. Line .................. REPAIR/ADDITION#Prey. Sanitation Permit Date --•<--•- :._._--__-. - -----• ....----•- ) Septic Tank (Specify Requirements)......................... ..//.. _._r_te_ s...._... — - _ Field (S €y Requirements) -T-Za�•-- •-•-----.� -----.---- -------------- '.., T ........-•......-•-...•- ------•--••----..---- _.----•--- ....._..........- ------------------------------------------------------ ..••..... .-------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thcit;the work wIII 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 Ilan-- sed agents signature certifies the following: y ` "I certify that In the performance of the work for which this permit is issuid; I shall not employ,6ny person in such manner as to become subject to Workman's Compensation laws of California." ' P Signed-- -------- ------- BY -------- hao ---------------....... ----_--.-. J'itle If of er Tn owner '4 FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED 13Y ..... DATE - r--./.- ................... ------------------------------------------- BUILDING PERMIT ISSUED --------- •--- - DATE -------------------------------------------- ADDITIONAL COMMENTS ---=�i .........._------------------------------- ----••^--- .................................................. --•---------------------- ---•-----•----------------•--•------•--- ------ _ -••-----•------- �- --•------------ - -------------------------------- ----------------------------------V ... . Final Inspection by: .. ©ate - .. .� ............... 13 24 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h3M ftev.