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OR OFFICE USE: . .v ......................... APPLICATION ICOR SANITATION-PERMO, 4 1 ............. .................... . ..... 1Catnplets in=Tri itcatel. �,. Permit NoT l.1-��. .._._ i This Permit Expires �w t Year Freta Date issued Date Issued Application is hereby made to the Son JoaquinlLocaI Health District for a per to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.. s� . JOB ADDRESS/LOCATION 7 j - Owner's Name ................. Owner's ,.....,....... ........ hone . Ci Contractor's a .-•-•••---.---•- actor's Name .._..-----•_--- � /..................... -- ----... . -----_.L€cense# ' ._.. one � Installation will serve: Res3derice Apment House Commercial . artH ❑TralterlCourt I] Motel ❑Other-------- ,��.-ti,-�, -..._.......•.._ Number f living ` o �wng units:_.._-• __--. Number of bedrooms Garbage,Grinder %Up { --_Y_ ----- Lot Size /� Water Supply: Public System and natrie i - s-- • ................. .............. [ .-------............... • . Character of sail to a depth ,...•--�- ...............-Private ❑. - 0 of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy�t oam {� Clay Loam Hardpan 0 f—Kdobe ""fill Moterlal 1 r type x .. If yea, a............... ....... � (Plat plan, showing size./of ltot,, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: / (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTI C TANK `` .6 Six ..._..:. t... /./.. •--••---••••. Liquid Depth Capacity /6� .._ ..---� ,- ----• .. Type V Material.._ No. Compartments Distance to nearest: Well i---. -.Foundation /� -.._. Prop --------- Distance . LEACHING.LANE No. of Lines �� -•_. Lengt . ............. hof each l€ne..___•��•..---•....... Total Length /�D � t ---------------• 'D' Box ....---._... Type Filter Material - ---Depth Filter Material �.�- " �\Distance to nearest: Well -----• - ... .... at ,1 ::it ..•...............e• Foundation _..1.o. _..:_.._ Property Line I .._.. SEEPAGE_P Pr rty .--•-•-......... fy -..,, � Depth _..J'R..:__.-•-__-. Diameter � .__ .._-- Number ---_-...... ...--- d Ye No ] ►"�SWater Table Depth yt A7, Rock Sire y --F / i es Distance.-to nedreit:•I 611_.'--------•- ..foundationf l r �'``•-.-. Prop. Line . REPAIR%ADDITION(Prev. Sanitation Permit#...__.•...:.-- ............... _— ----•------- --------•--•--..._ Date .... Septic Tank 5 ( petify Requirements) ...:.----------------------- Disposal,. -. - �` ? �Disposal,.Field_fSpecify Requirements . -' g ......-- ........................_--•-•------..... ........................... `1 -�� . .. ------------ -------------- (Drowexisting and required ddition-nn reverse-slide) 1 hereby certify that I have prepared this application and that .tire work will be done in accordance with San Joaquln County Ordinances, State Laws, and Rules and Regulations of We San Joaquin Local Health;Distrlit. Home owner or licen- sed agents signature certifies the following: "t 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-Corrrlsensation Laws of'_Califarnin."" Signed --- ---------•- --- ---- Owner ------ By ..__.. f ------ • Title --------- I f other a - -. ------1: - owner . R DEPARTMENT USE ONLY APPLICATION ACCEPTED B BUILDING PERMIT ISSUED z. t :_ -- -.-- .__...--•--.._...._.._..---...DATE.....//--Z..`I_..-..�.. - ADDITIONAL COMMENTS ............. _-.---------- ---------------•--------............DATE ..:. _..-.......... .------••---------•- -- ------•---_- --------•----------------•--------------- .._.._.................................. .------ Final Inspection by: ..._ ........ - ...................................................._.....Date ../7� J ,..... _ SAN JOAQUIN :LOCAL HEALTH DISTRICT $I7�i 3M .