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FOR OFFICE USE: APPLICATION r '`3:I LICATION FOR^SANITATION PERMIT .............. .. Permit No. . (Complete in Triplicate) ................................ _.... This Permit Expires 1 Year From bate Issued Date Issued_._ �A.:.V 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!: {�— . .... � ADDRESS/LOCATION!:,_.,. .......::.............._.._.._..............._Ci:NSi15 TRACT ........... ....... Owner's Name .................. ..........................................•--•--........•............----_•----...••...._................. Phone ....1a6 .x',8.3: ............ Address ...........................'!.....................:................................................... City ............................................................................. j Contractor's Name ....B1 kax'd-l-s............... -----.......License # 26-a.9.51....... Phone 6. •- .Q?� .... Installation will serve: Residence E Apartment House CQ Commercial []Trailer Court 0 Motel ❑Other ............................................ Number of living units:..1 ...... Number of bedrooms ....3......Garbage Grinder ............ Lot$124_X14.0.................................: Water Supply: Public Systelrii and name Private (rO7l7Y1 ............... _..�................................... Q Character of soil to a depth!of 3 feet: Sand.r] Silt Q Clay ❑ Peat❑ Son.dy Loam Q Clay Loam ❑ Hardpan Q Adobe® Fill Material ------------ I(yes,type ....................... !. 1 (Plot plan, showing size of lot,,�.(•ocation:of—system_ir�-reJ.ation to-wells,—wells, , ' tc,, 'mu$t be placed on reverse side.) NEW INSTALLATION: (NW septic tank or seepage pit permitted if public sewer"is available within 200 feet,)` PACKAGE TREATMENT ( ]i SEPTIC TANK L ,-.. Siae.......��........................ Liquid DePt.=.�......••---•-•------ Copacity .�.2�}.Q..__. Type ..: ......�;•- Material.-- e, CU. Jo. Compartments ...:.. ............:.J u -•.� Di Dance to nearest: Well ............Foundation-- __j-al.,_.,,.... Prop. Line ..... ;-•-----.--..- LEACHING LINE (x] No'""of'C+nes ` ' ........_.2.....__-•-- Length of each line...... .......5....__.-+=,Total Length .......... 5......-...... • j •' Box ::._�1._.... Type Filter Material .'.:_.Depth f=ilter Material 1.9............ F Sump C]Istance to nearest: Well _.�,....,,........... Foundation JD!............. Property Line ' ,SEEPAGE Pff 7 j Dept th . ....... Diameter .. ..X8.1.. Number _....---...2.......-.--•--. Rock'Filled Yesj:] No ❑ 9r 11—Vpble Depth. ...t............,�D'--_-_,___. ---,.,.Rock Size ......2i.-•--•••I.............., 0 . Distance to nearest: Well Foundation ........1.0.i .Prop. Line 5-P.. 7 F i REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..........I........................I Septic Tank (Specify Reci irements) ................1200--.gaa................................................ Disposal Field (Specify ( .'' 150 ' peach Lane & Sumps (2)4'X8'X10 ' Requirements) I 1 } III 4JS a -_._.__--»_______ ............ ___i................ ....:.................. ........................_..__._.......____._._.._......________ .....................I........ .......... (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 licert- sed agents signature certifi� 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 Wolkman's Compensation laws of California." _.. Signed .. ............i.•---••--- --- ---- ner:. �.. 8y ----...._._ J..:l:..._..... Contactor � .� - .a Title ..__ (If other than owner) c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...............................•-•--•--•_---•.._. DATE __..`�—.1.�.:-' ---••- -•--- BUILDING PERMIT ISSUED �� .............................................................DATi° ADDITIONALCOMMENTS ,!Ih............. ...............................................................-................................... ----------...._••--...... .-' .-•.............•--.......--------•- •. 'll' E ..... . .. ..................... .••... . ............................................................. .. . . . .... ----•---._...---.....---•-... ................... ............. ..................... Final Inspection b ..... Ir...... ......................... p _...,, Y ..._• �'—��-- _� �'i{.�-fid• � •, -� • ;;;• •- __. . ,_Date: _��;� .��,.. SAN JOAQUIN LOCAL `HEALTH DISTRICT t� ::..E. H.13 241.'68 Rev._5M 7/723-M