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a FOR OFFICE 05E: APPLICATION FOR SANITATION PERMIT {Complete in Triplicate) Permit No. .:7 ....�5..... ------ This Permit Expires 1 Year From Date Issued Date Issued _:Z .'? . 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/LOCAOa N l�. �.�.. �.� " _.._...... ._� - ..............CENSUS TRACT ....... _-_Owner's Name .... . �................. .................. - ..Phone .� ��3....•... Address .. f. �0. e•#,�-r!1...! �.. , ....--••--•--. City - -- Contractor's Name ...._._. .. ...�... d � - License # . .. - - --- Phone Installation will serve: Residence ❑ Apartment House CommercialT railer Court ❑ t Motel ❑ Other .._... ...:.. Number 'of living units:... ...... Number of bedrooms ..-._.--___Garbage Grinder Lot Size ..... .:.......-........__._.._._.,......... ` Water Supply: Public System and name ............. I ---. -----.•--....._..._.._.___......_.__............_..............._..Private �' ! Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam`% Clay Loam � 1 i Hardpan ❑ Adobe E] Fill Material ...._. ..... If yes, type ........... ................ (Piotelan, 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,) , PACKAGEJREATMENT [ I SEPTIC TANK Size---....,�Q--X-V.................... ..... Liquid Depth .__.7..7- : �_....._...._ Capacity A Type Material.. r. No. Compartments ............ ' Distance to nearest t;Well ....... 8_.,^7�.., Prop. Line _...S.............� LEACHING LINE No. of Lines ... - _.... Length of each line. ...:1 .._.._.. .... Total Length _. - ................... D' Box .... Type Filter Material): _ Depth Filter Material -.._..1 ............................... r Distance to nearest: Well _._.�L ._ ka_. Foundation ` Property.../..�--------------- Pro er Line - - -•-----• SEEPAGE=P.I.T_.[,.] �...� Depth_...._. , Diameter _.----------- ''4_Nu be _•.—�..._ ..._._. Rock Filled Yes ❑ No Water Table Depth - ------------ ----------------------�`-'�-----Rock Size ..................... Distance to nearest: Well ...................................... Foundation Prop. Line ...................15;;F REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------_ ------ Date .................................. Septic Tanis (Specify Requirements) ........... . .. .. ,_*�. !".:. ,:,.--.. ..........._._............... .......... Disposal Field (Specify Requiremen s) ----------- ....... ........•. ------- 1 (Dr4'w existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work -A;ill be done in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin L'ocal?Heilith"Disincf. 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 i as to become subject to Workman's Compensation laws of California." Signed .... .......�Oxer . ........... . .. .....�. ------------------------------- -•---._ Owner BY ..-- - - . r ._. _ ---------------•- .........- . . Title ... .... .....---......._._. ................_..__.......---- --• ( n owner) O DE RTM;ENT USE -ONLY*, APPLICATION ACCEPTED BY ._.. `.. ._.... .. ..... ...................._.. DATE ........ BUILDING PERMIT ISSUED ................. . .....DATE . ....._........------ ADDITIONAL COMMENTS -------- ---- ----- ----•- .._..__---_---------•--------- ---- ---- .....-- • • • --- • •- ___ ------...._._.-•----------- ...----------------------------------- . •---......... ---------- ------• -1.... OFF Final Inspection by: .... -- `.. .....Date ..� ��.� '._..._......_. 1 SAN JOAQUIN LOCAL HEALTH DISTRICT .. ;