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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SAN TATION PERMIT -----------_-----___+ �� i r . .� - 1 r-�. \ '� l Permit No,_ ,� �(Camplet�in�Trip#icate)l �� R I G 7 ---------------f \ s Date Issued.__f______________ t .....-_-___'°______________________________._.__._.__.__ This Permit Expires 1 Year From te Issued 00 Application is hereby made to the.san Joaquin Local Wealth District,for a peo�cbn�tr`uct and install te'work he ein de ribed. This application is made in compliance with C unty Ordinance NoX549 and existmgE:Rules�and Regulations: ' i r JOB ADDRESS LOC N. / �; = f CENSUS TRACT, ---- ------- -- ----- ' �. 7 � ---- - - -------- � Owner's Name.--- - ' �L...�- --- - -----�5.--•--------------- - � - -Phone ---------------------------------- I -- Address - E City zip - ----_---- t l „ i, Contractor's Name.__.____: ' _ 0. " � _ _ _ -License # _F��: .3�`Phone__ = � 1 I +. ` Installation Willi serve: Residence �artmentfHouse ❑ Commercial Trailer Court ❑ : . Mate1 [] r Other--------- =------ ------ -- ---- `---- =- Nutmber of living units: ` _ Number..of,bedrooms __Garbage Grinder ;_Lct,..SSize____ ----------- Water __. ._.Water Supply: Public System and name------------------ - '--- ------------------I- --.-.----- ------------- ------------- Private [�,.� Character of soil to a depth of 3 feet: Sand 0 'Silt Clay, ❑ : Peat ❑ Sandy Loam:❑ Clay Loam ❑ r Hardpan❑ !"Adobe - ill 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: (N6*sepf fank`or seepage pit permitted-if public �wer is available within 200 feet,) J i PACKAGE TREATMENT [ ] SEPTIC TANK ize_____' _ _,��" ___.F______________ Li uid 'De th_.___ _..__211�� �l�' �--- -�� - q P Capacity -,/ TYPe .� ateriaL. 14e.,* a 'No. Compartments----------------------------- t - D' tance.to°,near.est:-Well.::----5 -------------------------F ndatil on__1.1_ ------------Pro . Line-rSf=---.--- ---- LEACHING LINE' [ No. of Lines--_- t%�'_�Len' th-of each.lina.__ Totdl Length. ` g, -- - . 'D' B '' ."-.Type Filter Material- ;__ ..De th Filter Material.____ ____.___._________------------------------ ox-1, _ + :LYp t� ; p : , Distan4vto nearest: Well_'_• ___ ------------Foundation_____ ________--_:.__._____.PropertyLine__ - �i SEEPAGEPIT Depth�,�__._.Diameter. ----------Number-_ Sr Rock Filled : Yes o ❑ ..V--- ' Water Table'Depth---- = - =- --=--��- ---- ---------------- ---- -Rock -Size-- -- --- -- ------------------- : Distance to nearest: Well_`.__/QED-----------------__-----------Foundation d_f__,-____`-.Prop Line_._-S__'1=____ REPAIR/ADDITION (Preva Sanitation-Permit-#-------- --------------------------_----------"'Date-°-------- ±------ -------------- -----1 Septic Tank (Specify Requirements) ---------==---------=--------------- -- -- --- - ------=------------------------------ = ---------------- ---- DisposalField (Specify Requirements)------------ -------- -------------------------:-----------------------------------------.------------------------------------------------------------- ---- -------------'----------------------------- `-------- -------------- , {Draw existing and required addition on reverse side} I hereby certify that 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 licegsed agents signature certifies the following:* ' "I certify that in the performance of the'work for which this permit is issued, I shall not employ any person in such Aanner as to become subject to Workman's Compensation; laws of California.',". s # 7 Signed--r ------ Owner BY j r : Title . .. --- - --- : -(if other than .owner) r r R DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY-- ------ --------_-----------=--------- ...... . ..... ...........- DATE -� ^/�-------------- DIVISION OF LAND NUMBER.--- DATE - ' -- ------------------------ ---- --------- ADDITIONAL COMMENTS - ------- ----- ` ---- ------ -- ---------- --------------- - --------------------------------------------- -- - - ------------------ ----------..---- ---- ----------------------------- --------------- -------------- --------- --- ------- -- ---- -- j� Finar -inspection b y. ,/- '- ---_ - ---_------SAN JOAQUIN LOCAL WEALTH DISTRICT- ---'-_ --- EH 13 24 Date -'� _ �_ y-121677 RE �e 3M l-Ins f r