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FOR OFFICE USE: APPS CATION FOR SANITATION' PERS` 73-al-S (Comp;ete 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 County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... rs¢ sy - � �� 1/ ._.. ..... . ._......... ......CENSUS TRACT ............ ... p Owner's Name ....IV,441be� :..-...- `� ie-.p ..............r------------------------ Phone i Address 1.A/'- 11J1 A...-.------------------------------------------ city r9 1b ----------•-----------------•--.------ Contractor's Name -- , .r.1s.....1-C21L.t%.6:.1 .------------------- -------------------License .. Phone �..JW.5iK... Installation will serve: Residence X Apartment House-E] Commercial ❑Trailer Court a I Motel ❑ Other ------------------------- ' Number of living units:-.- ... Number of bedrooms _1- ----Garbage Grinder ............ lot Size ........ Water Supply: Public System and nam_ e ---------------------------•--------------------------- .....................---------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand b -`Silt-E] Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ ' Hardpan ❑ Adobe 0• Fill Material -........... If yes, type ---------I.................. � 4 (Plot plan, showing sire of. ;at, location of system in relation to wells, buildings, etc. must be paced on reverse side.) Q NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) on PACKAGE TREATMENT j ] SEPTIC TANK ] Size................................................ LiquidAepth --------------------------- 6pacity -------------------- Type .................... Material---------------------- No. Compbrtments .......---- ,.Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...........__.`_....... 4 LEACHING LINE [ ] Nd. of Lines ........................ length of each line....--------..--............ Total length ....................l....... 'D' Box............. Type Filter Material ....................Depth Filter Material _............_..: ............. Distance to nearest: Well ----.-... _---- _._._ Foundation ---------............:.. Property Line .......---.-..-`.-....., SEEPAGE PIT r ] Depth ----- -------------- Diameter ................. Number -------...------- .......... Rock Filled Yes ❑ No C Water Table Depth -------_--- ................... -----------Rock Size ................ ----- � 1 Xyt Distance to nearest: Well ........................................Foundation ..--_.--..._.. ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -f........-...--------------------•----..... Date .................................. Septic Tank (Specify Requirements) .............. --------------•;•----------------•--------------._.•-...._.----....._.. ,. Disposal Field (Specify Requirements) -... 40 �......--�E.�45_a,, __1.1 . --------------------_-----..---- ...................._--------------..-._.__.-- - ---------------------- .< ... _... . .....-.. ----------------- -------------------------------- •--- ...-- ..= `''.(Prow-existing and required addition on reverse side) ` f hereby certify that I have prepparedsthis application and that the work will be done in accordance with San Joaquin County Ordinances, State laws, and�Rules and Rejulations of the San Joaquin local Health District. Home owner or liven- sed agents signature certifies4he following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject i +Wo kman's Compensation laws of California." Signed .. .�,.. .....--- - --- --------- ------- Owner - B .---------- ----- -Title ........�..---- y .... ... --1r...:--..... (If other than owner) ~ FOR DEPAR �..- NT USE ONLY! # �� ` ,�� ► ' APPLICATION ACCEPTED BYE.{ _... ....-. - i - � --- .. - -•-- �---- '.� DATE .:... .. . �.'" ' BUILDING PERMIT ISSUED 1.- :- ....- -' "" ' -•--'�:: ...:.... ....-----.... --� `---. --. :-- -BATE ........-}.. .... ADDITIONAL COMMENTS ------------------------------•-- '•---------•-•--------------=-------- --R -.• :-.........--.... :... - -- r ---------`-------------- Final inspection by: ... ............ .- E>.-�= --- .f. ---- -' -... --_ - . ------- ------- -----•--------------•----------------- Date . _. _ .._. S . AN JOA IN LOCAL HEALTH DISTRICT