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FOR OFFICE USE: APPLICATION POR SANITATION PERMIT (Ca ' In Triplicate) Permit No. ..................... ............. This POn"It Expires I Year from Dat*Issued Date Issued ..................... a..� 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 and e.1n compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI f CJS ,.. ........ . . ........ . . . TRACT Owner's Name -- ? . Phone d Address ............ ......... ....._ City . .. Contractor's Name r License ... ...— .i --- Phone Installation will serve Residence A artment House Commercial - A ❑ oTraller Court I Motel ❑Other....................... ' �Numr living units:'`.._ -___:._ Number of bedrooms .......Garbage Grinder Lot Size Water Supply: Public System and name J I � r. \\�7j .........-- _ ......��__....'.�..................w......___...... .................................................... T .. ...__ .....�5....................•... .................Private Character of sof)lo aidepth of 9 feet: Sand Silt Ga ❑ Y ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan[ Adolae'� Fill Material ............ If yes,type (Plot plan, stiawing�site 046t,` location of ystem in Wiation�to wells, 'buildings, etc. e,ust be placed on reverse side.) NEW iIVSTALlAT10N: (No septic or seepage pit permitted if public sewer fs available with n 208 feet,] PACKAGE TREATMENT j] rt �SEPTIC TANK ' w+-4: Size.--•------•-•.....................:............. Liquid�Depth .............f..........•-�. Ca acs Material................. No Compartments a Type Distance. to nearest: Well ......... :.:.......:.Foundation.. Pro Line O LEACHING LINE p' [ j No. of Lines .. .............. Len th of each line_...._......_...... •-_-. Total Length D' Sox ............ Type Filter Material r ....Depth .Filter Material rn } Distance to nearest: Well -. Foundation ............. .... .... Property Line .._ ! .....•--......... SEEPAGE PIT [ j Depth Diameter ............ .�_ Number ----:...._........!_ ----.... Rack Filled Yes 13 No Water Table Depth ............. .................. --------------Rock Size Distance to nearest: Well --------------------•-- _ ....._.. -_ Foundation REPAIRJA©1HTION(Prev. Sanitation Permit# Prop. Line .........--•---.-•---- l ..-...�.,..,.�, -----•.............:::.. Date .._ Septic Tank (Specify Requirements)... .........----------- _. Disposal Field {Specify Requirements] ----- .. ! ...................... ••- -_------- ....... ------- --------•- ------------------------ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and th at the work will be done In accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin local HOW*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, it shall not employ any person In such manner as to become subject to Workman's Compensation laws of-California." Signed _...---- -------- -------------- ---• . ........ ..... .. ..... .. ................................... Owner By If other t a owner) .- --------------•-------•-•- yitfe - FOR SPAR ENT USE ONk1,Y` APPLICATION ACCEPTED BY I I BUILDING PERMIT ISS ED ----------- -- ----- - ------ ---- ----------- DATE 1..:. Z.. ' .:.._...._ ADDITIONAL COMMENTS ................... . . ._.__.....................................-�----- ---------------DATE •................ _ .. . - -••-••-----•-..............- ------------ ------- - - ----- . I •-------- ------- { ; Final Inspection b °:.............:............ _ .. EH ti Date 13 2!t 1-613 i v. i ., ,, F _ SAN JOA'0111 LOCAL HEALTH DISTRICT 8/7h