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FOR OFFICE USE: f APPLICATION FOIL7.SANITATION PERMIT .. � d3 --------------- ----- ----.--....... .......--•-••---••- Permit No. .:......�........:.: F (Complete in Triplicate) ...........................1111.----------11.1...... .---- ' Date Issued 1 �] - This Permit Expires I Year From bate 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. 549 and existing Rules and Regulations. �r\ J / T/ .. I�-' ...............CENSUS TRACT JOB ADDRESS LOCATION ... .. • ••�VV ..............:........... F ._ 1111 I'h Owner's Name ......... .....Phone ... Address1..... -X-•--••--------------------------------------•... city ......_..-.................. Contractor's N e .-...License #omL ,/_ -`] Phone , a� rF� Installation will serve: ResidenceXApartment House❑ Commercial Efrailedtourt ❑ Motel ❑Other ............................................ Number of living units:... Number of be rooms ... __ _.Garbage Gri er-7Z -- Lot Size .1;f7cr `............ Water Supply: Public System and name ------ -- ------111.1 _.. _---.---- __..._____._._.__..._ ..........................Private Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay loam ❑ 4, # i Hardpan Adobe❑ Fill Material _........_ If yes,type ............................ — i (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, must be placed an reverse°side.) NEW INSTALLATION: (No septic tank or seepage pit ,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ] SEPTIC TANK Size-- 'S1 f'XrX-,-lf - • .. . . . .. ........... Liquid Depth .:�.�........:.,.......,_ Capacity QG. ! .. Type J Material.e No. Compartments ._.:' __.....___� Distance to nearest: Well .-..S'. .....................Foundation / . .......__ Prop. Line .: -------------- LEACHING LINE - No, of Lines ..........2............. Length of 9ach ,/�line---------iS` ._�..... Total Length _ `��........6 'D' Box A&12 h... �� . �. .....�.... Type Filter Material Depth Filter Material --�----.._..---•........................ Distance to nearest: Well ._1W.............. Foundation .............. Property Line .-.5.................. I SEEPAGE PIT . f Depth ......... Diameter ... Number ---------------------------. Rock Filled Yes No Water Table Depth , 57 V' --------. ....................Rock Size ~ Distance to nearest: Well ...1,rra.... Foundation a ` I .......... Prop. Line ......:.............. . ...:.... 1111 ..---._.........� REPAIR/ADDITION(Prev. Sanitation Permit# ............................... Date Septic'Tank (Specify Requirements) ..................._......---•----•--........-•---........-•--•----.......--••-•--•-•----•--.........--•---•.................-•-•-- DisposalField (Specify Requirements) ..............................-.............................................-..............I...... •------ ...............a► -------------- ":_...---------...---•--•--••--••--•-••--•------------•----•--•--................---................------------•-----•-•-•--...._..----•--•--••. . . €. ----------•.........................................................................•......._.........------•-----•-----•----•--....----- �. (Draw existing and required addition on reverse side) I hereby certify that #)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 liven• i sed 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 manner ' as to become subject to Workman's Compensation laws of California." S€fined ----------------- :11.11.., -------- Owner ..-- -:1111. BY ;title _.._� _1 111 . _s��/L ... .. . Nk. {If other than owner) *ct e, . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ...__jen ...-----•.................................................................1111.. DATE ............. BUILDING PERMIT ISSUED -Y_n --- DATE ....................................... ADDITIONAL COMMENTS ... � __-� ( '-k_ _ V. y ...................................... i ................................................................................................................................................................ --•--• ....................I.......... ................................. .. ... .. ..- •---- •-- ••----._ ..._ 11.11.. Final Inspection by: _1.1.11 .......................... ...... .. .... ... _._ 1111 --•-••-- - - 111.1.._. ...._.... f .........•......... .............. - ...1111......---•--Datej �._.?P SAN JOAQUIN LOCAL HEALTH DISTRICT F. w-13 24 t.-AA Aa,. _qAn 14:f2_3 M