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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ................ . .. ........ 1--------_ _ iComplete in Triplicate) Permit No. ...�:5.•---•� . ........... Date issued ......................................................... . This Permit Expires 1 Year From Dater 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 existing Rules and Regulations: JOB ADDRESS/LOCAT N ..44�T.:°.. � .P..l .. a •••................................CENSUS TRACT .......................... Owner's Name .....: .:_ �_ . ...{ . y � •-- ............ ................ ............Phone .i�.6_...... :._. Address --QQj 6,�... .......... ... city Contractor's Name _ f. _►� a ,6 ._ m --. .License # .......I................. Phone Installation will serve: Residence KAportment House❑ Commercial❑Trailer Court C] Motel []Other Number of living units:_. ........ Number of bedrooms , l.�...::_.Garbe a rinder ....... .... Lot$I ... ...... ................ Water Supply: Public System and name ----•.------•..- .---•----•--- ----------------- �..: °`.......Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt o 'Clay ❑ Peat Sandy Loam 0 Clay Loom Hardpan(] r' Adobe te Fill Material .........4.. If yes,type............... ............ . (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 publlc sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TAMCi --..�...�------------------ Liquid Depth.... .�.-•----•-•-S Capacity.�_�f�:C� Type LA,07- Material . -.---.....• --- No. Compartments .....�..'.............� Distance to nearest: Well -----Kp.ti.,F;7........ ... 2>Foun©©dation ...-.f�-...:.... Prop. Line .........��....:.5 LEACHING LINE No. of Lines ----- ----------------- Length of each Dldine•---- FJ�.r---.--._.. Total Length ......� ........ 'D' Box ...:.._...-- Type Filter Material�_h-f ._Depth .Filter Material /g`./................................. Distance to nearest; We 11 _: ? . ?....__.__. Fou dation __ © .... ------- Property Eine .......7............. SEEPAGE PIT Depth Diameter..... Number .... .......... ............ Rock Filled Yes No ❑p' Water Table Depth °-•-=----��-•-......•--•-----------------Rock Size Distance to nearest: Well .....:._a uF........................ ation ..�0._.__..... Prop. Line .......�... ... Date .._ Foun - REPAIR/ADDITION(Prev. Sanitation Permit# .............-------------------------- • .............................. k Septic Tank {Specify Requirements) Disposal Field I (Specify Requirements) ---------------`---------........---.... . ... -•••. , -----•--------------------- ---------------•----- -----------------...._.. -_ -------------------------- ...__. (Draw existingand 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 Son Joaquin Local Health,District. Home owner or licen- ,;--zed 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 beco subject torkman's Ca anon laws of California." Signed _ _ . .-� ...._ BY ----- ----------- --------------_---------------------- $w Title _. (if other than owner) FOR DEPARTT ONJtY APPLICATION ACCEPTED BY --------------------------------------- ---•-•-• 11. - ---------------- DATE ...%a'-1Y-7 i'_....'__..._.-...- BUILDING PERMIT ISSUED ------------- --- -------- --------------DATE ........................................... ADDITIONAL COMM ------------ -- -- ••. ---- - ---------------- --- ----------------•-- ------ •- -- ---.------- ........------..........................---••--------.....__I.....--•--.._..---------- - Q. ... . . ---------- Final Inspection by: -•-------•-- ©ate _..._ 4 iii J 3 2 1-6 i v. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M