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FOR OFFICE USE: -3��/�1 APPLICATION FOR SANITATION PERMlT / / _ .......................... .......... .., . ........._ • . , ..............:............................... 11 • (Complete in Triplicate! Permit No, ..7 _' . This Permit Explres'I•Year From Date Issued Date issued . 7S� 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: JOB ADDRESS/LOCA N .....L..l.. J -rT+ sed-. . . ..............CENSUS TRACT ............... Owner's Name ICy�� .. .�:�" ...Phone cJr 7— A.�- ... Address ......................... . :! '.O ... _ ._.... ._�. .......... . •--... ...fCity . Ch?�1X�tfi�� .. -.......... �j t Contractor's Name ............1.... .. -_ rr � // _ �?7 ..............::........License # `.,� ..�' Phone ......... (.-.&467 installation will serve: Residence OApartment House 0.Commercial t]Trailer Court Ef Motel ❑Other.......................... a g Lot Siae Number of living units............ Number of bedrooms ...3 Garba a Grinder --_.......... t Water Supply: Public System-and name .................................................. ............ .... 4� ---.,. ........................:.............Private Character of soil to a depth of 3 feet: Sand o Silt[J Clay _E] 'Peat❑ Sandy loam ❑ Clay Loam ❑ - f Hardpan J4 Adobe $( 'Fill M' ............ if yes,type ............ ................. (Plot pia � showing size of lot, location of system in relation t e is, 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 TREATMENTSEPTIC TANK -�b` C l Size.................... ........---- Liquid,Depth ............................ .J:� 1 , 4 Capacity -__-_. Type .................. . Material...................... No. Compartments ....................... t Distance o nearest: Well ..I._..�................Foundation ,r - Prop. Line ............. Z LEACHING LINENo.! of lines . length of each line............................ Total length [ l , . _...- . ..........L..... Box TYpe'Filter Material _ r :. ....Depth Filter Material �,•�,;�"S"'--_��`� � dation - r Line to nearest Well .�A.... -- ...... Foun EEPAGE PIT Depth .................... Diameter ..... Number Rock Filled Y es No D J (03_Water Table Depth ............ .. `" Rock 51ae - f Distance to nearest, Well ____._•..............................•..Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitotion `Pe*r.m- _i_t--#- �........ .._................................... Dote -r.....P........r.._:.................... CSeptic Tank (Specify Requirements) ............. 'Y ........... ............... ...............+..... !. ............ ................ Disposal Field (Specify Requirements) , -- ------------------------------- ---- .......................•---.......------........ .....-•--- :•, ,: .......................... .----•.....................•-----............-•----•.....------..........------......._........ . (Draw existing and requiredaddition 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-licen- sed agents signature certifies the following: `4r, 'I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner v as to become subject to Workman's Compensation laws of California.', Signed •---• ---------•.... .......... .... .. Owner _.-- -- .. . ... BY'............ ....... __.. . -....... t = .... . ............... Title .... .. .. .. .................................................. (If oth han owner) FOR DEPARTM T USE ONLY APPLICATION ACC PTSD BY .._ DATEr _ �.��'`:.- ILDING PERMIT ISSLfED ..................... ......... DATE ADDITIONAL COMMENTS .......-•----•--•-----------------'-------•-................. .............................--- ..................................... ......................I....__.......�.. �..... �.y.+ �._......�.....f ....................... Final Inspection by: .._..__.... /1 .... l: _ .. .........Date _............ .J .. .�.... SAN JQAQUINOC L HEAL H DISTRICT