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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT S- X63 (,Complete In Triplicate) -� m ............... _ ��------------------•---•- _ Permit rt No _. ... . This Permit Expires t Year From pate f to Issued .........................R.._ . ..-e Era 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N ... j.- -��"�`-- ��-•-•---L� - -••- ..........CENSUS TRACT Owner's Name -------- ---------------- ..........................................................Phone ..-............................... .. Address .__ ....... ..� ..,.... Llty ............... . ..._...............-................... Contractor's Name -------- _.__. :_. �,. -•• -- '`1✓� -- .-----, cense ' . Phone . , �. ( �� 666L r , Installation will serve: Residence❑Apartment Hou se❑ mmercial❑Trailer Court ] Motel ❑Other....... ......__......................... Number of living units:-/-------- Number of bedrooms __..Garbage Grinder ........:... Lot Size ... ................................. Water Supply: Public System and name _. ...... ---------------------..................................................... .._Private [❑ Character of soil to a depth of 3 feet: Sand[] Silt. Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe-❑ Fill Material ... If yes,type (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 permitted.permitted lif public sewer:is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK] ] Srze.'.1'.----•----------------*.......--•---..... Liquid Depth ................ Capacity ----•-••----------- Type ... '.._-'.--••- ,Natalia!-•-------------------- No. Compartments . � �11 Distance.to nearest: Well ----!Y.. , r , :'Y Foundation ...................... Prop. tine ...,....... o ; LEACHING LINE [ ] No. of Lines .................. Length,:�bf eachnet '-" -------------....... Total Length ___•--•-__.................. 0 D' Box Type Filter Material �s g•. bepth Filter Material i Yp Distance to nearest: ell ------------------------ Foundation -:_.-.. .--_............ Property Line SEEPAGE PIT [ ] Depth ,7_�A/. iometer ................ Number ....../------------------- Rock Filled Yes ❑ No OF, Water Table Depth ------------------------------------------------Rock Size r......--- Distance to nearest. Well ..._.......................•...........Foundation ------- ......... Prop. ;Line .................... REPAIR/ADDITION(Prev. Sanitation Permit# .......------------------------•--•--....... Date ..............................1A I Septic Tank (Specify Requirements) ............................... ......_......... ................ t Disposal Field (Specify Requirements) ------ .. ......t�----- ---------------------------------------•----- -------------------•-------------------------------- -----------------------------------------------•- -------------------------------------------•---- ----_-------------- ----- - --------------------------------------------------------- --••-•--------------- -------------------- --------------• -------------------------------------.--..._....._...:.... (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 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 subject to Workman's Compensation laws of California." Signed ........ -• ------ . ------ ------ Owner BYIr Title --------------- ------------------------ (I of er than owner) FOR PA TMENT51E ONLY APPLICATION ACCEPTED BY ---- ---L--- .---- -••-- •----- -- DATEQ;� BUILDINGPERMIT ISSUED -----------------•---•-------------------••----•------ --.._.----------------- .-------------.DATE ........... ................_._......._ .. ADDITIONAL COMMENTS ------------------------------•------------ ..... - -------------------•- --------------.. -------------- ---- ------------------------- -------- ........................-................ .. ----------------- --------- - ------- Final Inspection by: -•_-- •-•. Do ! � -•-- 13 24 1-613 v. SAN JOAQUIN L CAL HEALTH DISTRICT 8/7h 3M