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R OFFICE USE. - �- aPIcaoN FOR SANITATION PERMIT ••- �_.•. `�' 1Csdnplete In Triplicate) Permit No. .� This Permit Expires 2 Year from Date Date Issued s �� 7'C Issued Application is-hereby made to the San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No. 549 anermit to d sti and g Rules tand RRegul tions.n i JOS ADDRESS/LOCATiO �� • - .� ... .. 4 / ......CEN SS TRACT Owner's Name ..._..._.. �. . ....._..._ _. _ r.. -.......................Address �.. . ........- .-: Contractor's Name ........... ._......_ ........... .._.License#:a� .... ..: .. .. ... Phone Installation will serve: Residence Apartment House Commercial I }]Trailer Court ❑. ' Motel❑Other...... ........................... �. Number of living un'its:....._ -._-_ Number of bedrooms �r .?--.Garbage Grinder Lot Size Water Su - � pply: Public System and name ......._.- .----•--•- �: Character of soil to a depth of 3 feet: Sand -'.' '- =------:::.Private �]_ Silt Clay` _ ❑ Y.0- , .Peat❑*,.,..SarFdy loam [] Clay Loam . Hardpan p Adobe 14 Fill Material if -_-. ............ yes,typa............... (Plot plan; 'showing size of blot, 'location of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTA1LA1lON: ! (No septic tonic or seepage pit permitted if public sewer is available within 200 feet;] PACKAGE TREATMi NT 1J—SEPTIC TANK, ,,� Capacity � ( -• ............ .... __ ... Liquid Depth °. Yt�e? .._ . Material._ No. Compartments j Distance to nearest. Well ---._-- =�-�- -------------------Foundation ...1 a...._ r i LEACHING'LINE No. of Lines --••-- Prop. Line ... -----... Length of each ..line.--- _ . • � . �'.... ...........•- Tota! Length ._f.�!�?.- r'D' Box - g .............• Type Filter Material ... .. Depth Filter Material ....... s� r � .Distance to nearest: Wei! .... .-- r . Foundation1!2__f f.�Q f SEEPAGE PIT ... Property Line ... - .th - --- rDiameterrl & Number . Rock Filled Yes �{YeNo Water Fable Depth ..................................................Rock Size, Distance to nearest: Well ..'Foundation ----------------- p. Line IIEPAIit/ADDI -• Prop. ....:................. TION(Prev. Sanitation Permit�# ............................`Date Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ._.---------•- i-- -.... - . . _ _ V' 15Fdw existing and required addition on reverse side) ..... .----•-.._ •--- .................. _4 3,—I hereby certify�_thot I have prepared this application and that the work will be done in accordance wish San Joaquin oCounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or Ilcen- $41 agents signature certifies the following: ---N certify that in ehe 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." Si�nen _ vr f - .. Owner --- ---------- -- r �� = Jitle .-..-- �.. ' I otiie an owner) ...----•-- FOR DEPARTMENT USE ONLY- APPLICATION ACCEPTS BY - �. . '- --------------- -------_------------- ----_.. . DATE -,/2 BUILDING PERMIT ISSUED ---------------------- .._,....-. --..._..--•--...-•-----•---•---• - AbDITIONAL"COMMENTS ---.........I.. --- = --------,..DATE----- -- - ---.. ----- ........ Final Inspe b . .. .. `-- EH 13 2L 1-bil: ..-Rev. 1 `�" � � ----- ---------- ------Date . -- -LL_...- --. SAN JOAQUIN LOCAL HE I,TH DISTRICT 8/7h 3M