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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 137 ZComplete In Triplicate) Permit Na. .75`',._..._.... u ,, � . This Permit Expires 1 Year From Date Issued Date Issued ... ...: :. �^ Application is hereby made to the Sart Joaquin Local Health District for a permit to construct and Install the work herein described• This application is made In compliance with Co my Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... ; .._.. .:_... ..�.. ................. ...............................CENSUS TRACT ................. Owner's Name ... .. .. Phone ........ .. ........................ Address ........c7 Ci Contractor's Name . J ...../ C .. .... ---• . . -.......License l �P/M1� Phone7.. Installation will serve: Residence GApartment HouseQ Commercial QTrailer Court ] Mate) E]Other ............................................. _...--•---------•........ Number of living units_____________ Number of bedrooms Garbo a Grinder Lot Size AL t0x. xV............. ! Water Supply: Public System and name ..Private ❑ Character of soil to a depth of 3 feet; Sand 0 Silt Q —Clay Q Peat❑ Sandy Loam 0 Clay loam EJ "`Hardpan ❑ Adobe.0 Fill Material .......... If yes,type ............... ............ ; I (Plot plan, showing size of lot, 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,) i PACKAGE TREATMENT I ] SEPTIC TANK f } -Size........................................... ... Liquid Depth .........................: Capacity ............. Type------_--•-_---_ Material...................... No. Compartments ..................... Distance.to nearest: Well ....................................Foundation ........-- Prop. Line .........- ..._.. LEACHING LINE No. of Lines _--.- ._--. I ( ] f ----•--...... Length of each tine...._: ..5�-- Total Length -........6 � ,D. Box ............ Type Filter. Material ....................Depth .Filter Material ..........................................:. � Distance j nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE.PIT 13 Depth 6i 1b_. Diameter :..............:. Number .--_------_- _ - --.-....... Rock Filled Yes Er", No 0 � Water Table Depth .. Rock Size Q.Distance to nearest: Well l��- �.-....Foundation .................... Prop. Line ......� ........_.. , REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .................................. � SepticTank (Specify Requirements) ...:......... ............ ----•---•- .............-............._._.................-....................................................... 1 Disposal Field (Specify Requirements) ......_-.______---- E •------ J ------ ••-• ------------ -- -- --- -------- --- - { �' ----------- -- ------ ------------------------ Drawd � v .... ( existing and required addition on reverse side) 1 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: "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 We to orkm "Compensation to s of California." Signed ----:-` u _. U Owner BY --------••-----------•-------------------- ----------------------- Title -------- -•---• - ......... ------ ...................... (if other than owner) R DEPART NT USE ONLY APPLICATION ACCEPTED ,BY ----------------------- ...-------•------------------ .............. DATE .. .,....r...__...'��...... .. BUILDINGPERMIT ISSUED _... . ...ED ............ DATE - ADDITIONAL COMMENTS ---------------•--- ---------------- ----------------------------------------- ----------------- ----•-----.._..------------------------ :. • ----•.................................. : ......... ..• -•---- .............. .-...----......_-...---------------•--.....-..-. ----- --------------------------- ----------- ................................................. .. . .. ----- Final Inspection by ....Date ..... '. .. ............. .................................. ... .... ............ ........_.._....___.....-._.._...__..... `J EH 13 24 1-6 rev' 5mSAN JOAQUINLQCA! HEALTH DISTRICT 8/7I 3M