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VuX VrrrUe U,5t: APPLICATIONPO R SANITATION S A ON ............................................... )Complete in Triplicate) Permit No. .77.............. .................. ... .... ................. ........ This Parmit Expires t Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein described. This application Is made In compliance with 5ountj Ordinance No. 549 and existing Rules and Regulations, 00, .DOB ADDRESS/LOCATIO �T' ..`... 1. I..��.....--•....... . ................I.................,..................CENSUS TRAC .. �+ . ..... ..... Owner's Name .. . ... .�.�1........... ........ ............ ......................................Phone .59. '..Z.�Ard...... , Address .. .c77. ...� . ....... .................Cf �� ............. . e�-D ty ........-- �rlContractor's Name .... .......... ............:•-------......._........._...License � Phone 0 _ Installation will serve, Re d nce 04CP-0,rtment Houses] Commercial❑Trailer Court I] Motel❑Other .... ................... ......... Number of living units:-•----_--- Number of bedrooms A------Garbage Grinder ............ Lot Size ............................................ Water Supply, Public System and name ..................................__-------•-----•-------....................................................Private �� Character of soil too depth of 3 feet: Sand o S11t❑ Clay ❑ Peat❑ Sandy Loam {] day Loam ❑ Hardpan❑ Adobe❑ Fill Material ...:::...... If yes,type........................... (Plot plan, showing size of lot, location of system In relation toRwelIs, buildings, etc. must be placed on reverse title.) . NEW INSTALLATION, (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK f I Size..... ............ .............................. Liquid Depth .......................... Ep 147 Capacity n-�.r-41__!pepe ................� . Material...................... No. Compartments .... .......� i Distance to nearest: Well �� ......Foundation e............... Prop. Line a ............... LEACHING LINE [ j No. of Lines .5................. Length of each line_.7 .................. Total Length .r.��.��............ r 'D` Box I....... Type Filter Material 40;?,,-e Filter Material ! • , Distance to nearest: Well ........................ Foundation ........................ Property Line ...................... ; SEEPAGE [ I Depth .................... Diameter ................ Number ... ........................ Rock Filled Yes ❑ No Q ; Water Table Depth ...........................•- !-•-----......._.Rock.Size ................................ Distance to nearestt Well ........................................Founi ation .................... Prop. Line ---------------.....- r REPAIR/ADDITION(Prev. Sanitation Permit,lsI _........_ ...........-•-•--•-• ••-----. Date ................................ SepticTank (Specify Requirements) ......................................... .................... ..........................................._................................. Disposal Field (Specify Requirements) ................................................. ' . i - -••...............................•--•----.................--------••----.............------•--....._..... A .: :.------- ---......---•---•----................................................. - - -_... :fes.. ..-----.-•................•----•--............. .._ _ i_..._.......... ...................__...._....._._. S: - (Draw existing and re aired addition on reverse side) I hereby°certify that 1 have prepared this application acid that the. �work,will be done in accordance with San Joaquin County Ordinances, State Laws,_and Rules and Reguloffi;6s of the-San Joaquin Local Health District. Home owner of titan- 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 becom subject to Workman' Campo!salion laws of California." Signed ---- 1�°'� - . . ... ...................................................... Owner ----. yitle .........................•-•.---...................... ........... (if other than owner) s FOR DEPARTMEW USE ONLY : APPLICATION ACCEPTED BY .. ...._.:��.i�.-z'.�.z..�.......................... DATE ..�........---- ....._..._.. .. BUILDING PERMIT ISSUED ..DATE ....:...................................... .. ADDITIONAL COMMENTS .................................................... --.------..-y...--.----- ......................................... ...................... ............_...-----........ ,.... ..... ..... _ ..... .. ............. Final Inspection b .............Date ._.... ...---..._.. ........_........_ EH 13 24 1-5F1 Rev. �[ SAN OAQUIN LOCAL HEALTH DISTRICT 8/7L 3H