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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --...-•------ Permit NoT . ............ . .............. fCamplete In Triplicate). S^. ?•.................................. This Permit Expires 1 Year From 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 cotm..p..-l.-i.anLc.e with County ounty Ordinanc/n ce No'. 549 and existing Rules and Regulations. JOB ADDRESS/LOCAT N .............. o 7-127, 1 ..._ ......... ................CENSUS TRACT Owner's Name /J. ' ....................................... . . ............ one ...... ' Address -------•------ .. City .............._...: �O....T .. .► .----- Contractor's Name -------.�-1. PCZ.... # .' �.�. Phone Installation will serve: ResidenceApartment House J-] Commercial OTrailer Court Motel ❑Other.........•.................................. Number of living units:..._ ..__ Number of bedrooms Z.....Garbage Grinder ..._.__..._ Lot Size .2,ev.......A 5 Water Supply: Public System and name PP Y� .......-..........•......................•-•..............-------......----------------•.......................Privateer' ' Character of sail.to o depth of 3 feet: Sand t] Silt❑ Gay ❑ Peat❑ Sandy Loama Clay Loam ❑ Hardpan [] Adobe 0 Fill Material ............ 14 yea,ty ............... ............ (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 240 feet,) PACKAGE TREATMENT l' I SEPTIC TANK ] Size.....:...:............... .. Liquid Depth .......... Capacity Material....... -------- No. Compartments ---•-- ------------- Type ...__......._. ...---- .....................-t/� Distance to nearest: Well -------•---•........................Foundation ....:........._--_- Prop. Line ....... .............. LEACHING LINE No. of Lines --------- ---------- Length of each line-------�.o-40-......... Total Length .......(V.1'.7..'. W 'D' Box ---/...... Type Filter Material -Z! '. 'Depth Filter Material ......_..... . ........................ Distance to nearest: Well __/40402-------- -- Foundation .....I.�.......---- Property Line Q......._--� SEEPAGE PIT Depth __ TMJ --- Diameter Diameter ..s .._. Number ........../......... ..... Rock Filled YeX No de Water Table Depth ------------.2—10?' ..•----.._..-•_---Rock Size ........Z_�...._..... {J ' 'Distance to nearest: Well ----�04P.----------------------Foundation ....... Prop. Line ...�.-.�.!-•- REPAIR/ADDITION IPrev. Sanitation Permit# ---..--•.---•- ---------------_----------- Dote ............................ Septic Tank (Specify Requirements).__----------•-------------- ••-••••-- -------- .................... = Disposal Field (Specify Requir ents) -- -.�� ..... ------------------------ -- ......................... (Draw existing and required addition on reverse side) r 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. Horne 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." I Signed -- s .( ��r _.. `S _ ��." Owner BY - Title ------------ ....... -- - •- . FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY ._. -------------- ------•: DATE... .. X171. BUILDINGPERMIT ISSUED - -----.._.._...---------------------------------------••-•- .................----------DATE _........ -•-•--•---- ........ ADDITIONAL COM TS. ---- --- ------------•-------•-•._....-•-------------••-•----------.-.-- •- --- -- - - ---- ------------ ------------ --._._... ------- of ------------ -------------- -------- ----- Final Inspection by: ..-_ ..• . _ , ----- - , ....................................... Date .. .. .._ . .. . I ' 13 21a 1-6$ 13 v.' SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M r 4