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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .Y . :: . .............. Permit No. ..... ............ r (Complete in Triplicate) ' .......................1....__............... ,7 I ...................... This Permit Expires 1 Year From Date Issued Date Issued . '- ._........ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is maom pliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAPf �J ;.� _... .....................................CE .....• ............ CENSUS TRACT Owner's Name ....... �f. ..0-t...:.. . ^''. ........................................ .... Phone�� ,. 9i .7....---- Address ..............j. ... City _._... ._.....................----...... .................... _.. Contractor's Name ................... .... .. . .-License # �_;--�-�} �_. Phone ��61 � d-b� + -may- --� -- -------•............ ...... N,3 Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court 0 Motel E]Other .................... ................. Number of living units: {.._.._ Number of bedrooms _ .,z,�.__..Garbage GrEnder ............ Lot Size .__ . 0._. ./.r0................ Water Supply'.Oublic System and name ---------------------------------------•-•---...t..:A.�..::....._.. Private Character of sol <a-depth of-3 feet:....: Sand'❑..,,,.Silt❑_ Clay.[9.11 � Peat❑ Sandy Loam� Clay Loam C. Hardpan ❑ Adobe [] Fill Material ....� ..-. If-yes;type .................----------- {Piot pian, showing.sizetof lot, location of. system in relation to-welis buildings etc, must be-placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit-permitted if public s wet'is available within 200 feet,) PACKAGE TREATMENT ]—SEPTIC TANK Size-�•:�=:� _.^�.�...................... Liquid Depth ............... Nk. o: 4 � ' Capacity .._�-Type .. . .... .. ....... f futenal.;: No. Compartments ....`?—..... :... , I .11 Distance to nearest: Well ........ ... .......Foundation ...................... Prop. Line - --.-. •.-.._...... _......... Len th•of each line..-_-�.. Q_-.X..1__.. Total Le i f i le i LEACHING LINE [� No. of lines --- —�-- g �a ngth"; _. _ ................ 'D' Box .._.�_ Type Filter Material . .1� 4 `'...Depth Filter Material ...._. _./ a rl..._i_:1:......... 8 t , 'Distance to nearest: Wel[ ................. ry' Foundation .....1. ..�........... Praperty Line-. ``.�:.......... . SEEPAGE PITT [ ) Depth .... .e.. ^. Diameter ........... N rAI er ._ .................. Rock Filled Yes [❑ No 0 Water Table Depth ...:.r..................... .... m Rock Size .......................... . . Axa Distance to nearest: Well ..Founclatidn 3 .... = Prop. Line ------ -------- RIEPAIR/ADDITION(Prev. Sanitation Permit# ............................ .............. Date ± ..............................) Sepnts)'.._...? rtic Tank Requireme ......................"-- ----•----...-•�---............--•--..... ....__.X. .... ........_............. 5 Disposal Fig d—(Specify.,Requirements) .... = jI - ------ -----•-•- --- .....................-----------------------------------------------------------------w.. -......... ........................................................................................................--..._......................-................................ .................................... ' (Draw exisfing and,requirec) addition on reverse side) # I I hereby certify that I have prepared this applicctioVand' that the work will be done in accordance with San Joaquin County,Ordinances, State Laws, and Rules and Regulations of the San Joaquin;, o`cal Health District. Home owner or licen-sed agents signature certifies the following: `4 R I "I certify that in the performance of the work for which this permit is iau.ed, l'sha11 not employ any person lin such manner as to become subject to Workman's Compensation-laws of California." [ Signed ... __ :::........::.::... .`Owner By .............. ` .... n�ix . . .._. Title ............. ' f of a 'than owner) ' (_FOI! DEPARTMENT.,�IiSE ONLY APPLICATION ACCEPTED BY ............:: .. .................. DATE ..e BUILDING PERMIT ISSUED ----- - -- -----•--. ,�._....._ ATE ........... ADDITIONAL COMMENTS -.... -.. ?'y�__....... ��` _.... .. _. -+....................... .-•-•----.._....-•...........................................................• ........................................ .:............................................--- - ��---•- = _ . p y: --- ------. -- Date .a�...�1? -.�f ........... Final Inspection b ................ ....----........ .... .........----------- SAN JOAQUIN LOCAL' HEALTH DISTRICT u 1-1 24 7177 'A V