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G FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _...._..... ...._........................... .... 3 lComplete in Triplicate) Permit No. .. ...................................................•--.• This Permit Expires 1 Year From Date Issued Date Issued _.T.. _.._......... . Application is hereby made to the San Joaquin Local Wealth 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: .__ ..CENSUS TRACT ....................... . JOB ADDRESS/LOCATION ..�. ..�...�-G�...._...;�..t..... ... .............. . .sit._........._.._.._-.._. .. Owner's Name ...... ...---•.... •- •- -- -•............................ .. .-- .......P one .................................... Address . ..........:_......... 1�. -/I ...._ r.. ------ .......... CitY ---------------_ ...----........... Contractor's Name . .. ,1 ....�d a. � -,.e r '.c ..........License phone /152"Zxz ..�? Installation will serve: Residence A Apartment House-[:] Commercial r7roiler Court 0 Motel ❑Other � _ -f-------------•------- / ! Number of living units:......... Number of be rooms .___�_�_/_Garbage Grinder .-- - Lot Size ....v�s$__.., Izel........ Wafer Supply: Public System and name ..---. .......................................................Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loam 0 � Hardpan ❑ Adobe Lk Fill Material ............. If Yes, type --------.. ................. I (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 permittVd if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] X!l 7-96e'6� __________________:_......_........:.._. Liquid Depth ..................... n 3 Capacity .. . ...... .. Type __..._._._ --------- Material----_..-...- No. Compartments =4 1 ~ Distance to nearest: Well ............ ----------_......Foundation -.,.- .............. Prop. Line ---------............. `.1 I LEACHING LINE No. of Lines .... ..... Length of each line . . .... Total Length ...,674`............... D' Box . . Type Filter Material -------Depth- filter Material ......................... N Distance to nearest: Well Foundation _/4�.... Property Line .._ .----------I........ SEEPAGE PIT Depth '1.f.-_ Diameter Number ....... R 'Filled Yes L�r No ❑ V Water Table Depth ...__.��..Q..................................Rock Size ...aZ-. ---------- r Distance to nearest: Well . �.-____--Foundation ....... prop. line _._a................ REPAIR/ADDITION(Prev. Sanitation Permit# ..... ................. .......... Date ------------...................... ) r Septic Tank (Specify Requirements) .............. ---- .......... ------......__......._.... •--•-....._.. Disposal Field (Specify Requirements) i. - - ------- , -c- ` ..---- �� ---------------- ------. . ---....---- .----- - .......... (Dra'w existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dens 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 became subject to Workman's Compensation laws of California." Signed - ...... ...... .... - ............ ----- Owner I BY ...: .... . ..... .. ..........:.... ._. Title .. .. -(If other than owner) FOR DEPARTT USE ONLY APPLICATION ACCEPTED BY .fir, _ DATE .. ...7 . .`. .-�•................. BUILDING PERMIT ISSUED ._...._:-..._ _ .... ... ......................... ....... .......DATE _ ADDITIONAL COMMENTS ........ -- - - I�--_�. F.__ -.,. .................... ---------- -----•-------- -----..... -- ...........----..._......_................._..._... --...... •--•---------•--•................................. ----- ---------- ---------- :_.... � 7. ....__.... I Final Inspection by: .. ;.._. . Date .. ... SAN JOAQUIN LOCAL HEALTH DISTRICT