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--------- APPLICATION FOR YANITATION PERMIT (Complete In Triplicate) Permit No. ...2�.,-4/-- ................................... --- This Permit Expires I Year From Date Issued Date Issued .- ......... 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 xisting Rules and Regulations. JOB ADDRESS/LOCATION ... 0. � '•••�, •nI...C.C1. ' ........cervsus TRACT Owner's Name a� .. 5.../ /.�_�1.. • �,, � ...�_ ._ ......---•--....-:•................�....... ......Pone �. ...�-� Addressr .OQ..� , City /. .............. Contractor's Name _.___._.. / .�/L P --..License ../�.',---------------------......--------------------------- #a�C3..�/.•......_... Phone` Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other ........................... .................. Number of living units:.... Number of bedrooms -1— 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 o Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Materia) ............ If yes,type (Plot pian, 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,} PACKAGE* TREATMENT [ 1 SEPTIC TANK( ]'J!Xfl /�� Size...... . .. . . ... Liquid Depth jrp�.k 1 .._.._. apaaty _.3_ ------- T�ppt,•_•!�.(_.. aterial.-�` _ _ !��!C No. Compartments ..... j% Distance to nearest: Well ----/ Fou dation prop. Line _..4 " LEACHING LINE [ ] No. of Lines ------------------------ Length each line.- ------..-..............._ Total length 'D' Box ............ Type Filter Materi ............ .. .. .Depth Filter Material ................................... Distance to nearest: Well _...._.... ............ Fou ation .................-....... Property Line ... SEEPAGE PIT ____________ _______ Diameter .._-._-- Rock Filled Yes ❑ No ��_„ [ 1 Depth - ----------••------- umber ----- ---------------------- Table Depth ------------ .............---- Rock Size --------------- Distance to nearest: Well -. _.--- ----------- -------Foundation - ........ Prop. Line ......................REPAIR/ADDITION(Prev. Sanitation. Permit r# ... .. -.-_. ------- Date ------------------- Septic Tank (Specify Requirements) ____________ ___ . ........................... ....... .............. .......................................................... ,. Disposal Fi d IS ecify Requirements) --- r.... 61------ - -r�_�. -------- r_ /-� , s ......•--.. s - •--. - - ----------IDraw existing and required addition on reverse side} I hereby certify that 1 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 Comp sation laws of California." Signed --------------- ---- ---- ---- Owner By ----- (if---- ---- ------ ................. ....Title .other than ow er) --------------------- -------------------------- FOR DEPARTMENT USE ONLY y . --•-- APPLICATION ACCEPTED BY ------ --------------------------------- BUILDING PERMIT ISSUED -------------------- - ----••----...---- �-------...__.. --- .. DATE . . ..-- --•-•-------•-- -•--- ---------DATE: ..................... ... ADDITIONAL COMMENTS ---------•- • -•----••-- _..--�---• �---------•-------------- ----------- ------- ----------------------- ................... Final Inspection byk�t --- - .......................... • --.......---...- ----EH 13 2a 1-6 3 .................................... . Date SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7lI 3M