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FOR OFFICE USE: "'APPLICATION. .POR SANITATION PERMIT . 4 _ � + M 4 'r '�. _7.7-:lam/�. tCompleta In Triplicate) Permit No. u_ This Permlt)Expires I"Year-Frans ontetssued Date Issued Application is hereby made to•the San Joaquin Local Health District fora ' ` onsmict and described.This application Is made in compliance with County Ordinance permit and existing Rules tand Regulations rein JOB ADDRESS LOCATION ..._..........CENSUS TRACT .......................... Owner's Name ............ ,_�..-. . ...................................Phone .... Address ,._....� � ...... ...... .,........ city .l=._. ......... . Contractor's Name1r,,.-,._-_._-,_ .-,, Llrense # . _ --- f4 ...._ Phone � �� Installation will serve: Residence©Apartment House C) Commercial Wraller Court ] I Motel ❑Other Number of living units:_,,.L_,. Number of bedrooms ----+2_:..Garbage Grinder / -- Lot Size .................... . .. .... Water Supply: Public System and.name ....... .............................. ........ Q Character of soil to a depth of 3 feet: Sand❑ Silt❑ - Clay Q Peat❑ Sandy Loans ❑ Clay Loom ❑ ' Hardpan[] Adobe q Fill Material .........,.. If yes,type (Plot plan, showing size of lot, location of system In relation to wells, buildings, est, must be placed on reverse aide.) NEW INSTALLATION: lNo septic tank or seepage pit .permitted If public sewer Is available within:240-feet;]•---- ' F PACKAGE TREATMENTSEPTIC T ` F � ANIC� j Size---•--_:..-•-----••--•--........................ Liquid Depth ........................,-� Capacity ' Type .. Ma#erlal.__ --.—... --=---. No. Compartments .....---•.I........... S ' E w Distance.to nearest: Well -----------------•..................Foundation..................:.... Prop. Line ..... ................ LEACHING LINE1 No. of Lines ------------------------ Length of each line...._.................�.._-- Total Length ------•............... ....:. 'D'' Box Type Filter Material -.--.Depth Filter Material ............. ....•-• .... Distance to nearest: Well ................:....... Foundation ---......._.._.. ....... Property Line ........................ SEEPAGE PIT ( J Depth ----- _----------- Diameter ................ Number ....... _----... Rock Filled Yes ❑ No U Water Table Depth -•----------------------------------- ----------Rock Size ......... -----•.... ......... V' Distance to nearest: Well ------------------ --..Foundation .................... Prop. Line ...........:. 0 0 REPAIR/ADDITION(Prev. Sanitation Permit# --------------•---.:_-..--------------- Date ..........-:...................... ) C Septic Tank {Specify Requirements). ................ Disposal Field (Specify Requirements) ...............----------------•--- •--•••-- F .............•-'--... ' / --- r/ ............. ...... I hereby certify that 1 have prepared addition side) this e application and that t work will be done In accordance with San Joaquin County Ordinances, State Laws, acid 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 become subject to Workman'sf Compensation laws of California." Signed ------- '--- = - Owner -- - - ----- - --- ..... By .............. ........------ . Title _.. {If other than o nerl f -------------- . -- f FOIL DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._. ..._. . --•-.._... ---------------- " GATE _ BUILDING PERMIT ISSUED _.. DATE _ ..... " ------ I ADDITIONAL COMMENTS --- --'............................................... . ..........................•-•---•- e, 5M --------•----••--------------------• -••-----------•-- - ............----------......................................... --------------•-••------ Final Inspection by: -•- _..................... -•--•-•-•-----_•.Date _....._�� 5��I....-....--'---•......... 13 21a 1-613 SAKI JOAQUIN LOCAL HEALTHDISTRICT 8/7h 3P