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?-VK cJt't-[C:t USE: ls� �6 _ _i-fd `' PPLICATION FOR SANITATION PIAT �. _... - , 1fr( �r. - /f-'G (Complete in triplicate) Permit No- !. ....................... -� i�- Date Issued .:�j"_ 6 ....__,% � 1 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 compliance with County Ordinance No. 549 and existing Mules and Regulations- JOB ADDRESS/LOCATION __..... _ .. - �•--- t `. G �'" _��4 .. .......CENSUS TRACT ......... ...........•_-•- ffjj Owner's Name ... . f1..1.1-1 ......................:.....Phone . Address -. - � .../ l� ..�. .. .. . .. y .... . ..C.110%---------------- -------------- Contractor's Name - ------------•----------------------------License # .......... Phone Installation will serve: Residence prrpartment House❑ Commercial❑Trailer Court 0 Motel ❑Other-----------_----- Number --- -•----_----Number of living units:..----- Number of bedrooms _4_k___Garbage Grinder .. _ Lot Size Water Supply: Public System and name _.__-..---- _•--------_----------------------------------------- ..---Private ( �` Character of soil to a depth of 3 feet: Sand J200 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ iF1 Hardpan ❑ Adobe Q Fill Material .._._...._ If yes, type ............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) l^, NEW INSTALLATION: (No septic tank or seepage pit perrtiitted 'f public sewer is available within 200 feet,) _ PACKAGE TREATMENT [ ] SEPTIC TANK{ ] SVIJ) %/]�NiL' �� - - ------ -- -- ----------- Liquid Depth __........._..---......---. 64 Capacity Ype - ------ Material-------•---------_-- No. Compartments .............. y Distance to nearest: Well --------------•---_ .._..Foundation --_--.-_-----..-.--- Prop. Line __'-_----- -----------W !, LEACHING LINE [ ] No, of Lines - --_3--------- ----- Length of each line.----- _ -- ------ Total Length _....�--, - - J 'D' Box ............. Type Filter Material ! -.T!- C bepth Filter Material ------- - - -------- ---•--- Distance to nearest: Well ---. .. .. ......... Foundation _ _.....------- Property Line SEEPAGE PIT Depth Diameter __X.Z_f"*Number _IVC---------- Rock Filled Yes No,❑ Water table Depth -•:------t ----•------ /-•------------_ --- ------ --- _ Rock Size .- -- -- - ----------p. Distance to nearest: Well _.,,�_4.6---- ••................Foundation -- 0 -...--- Pro Line _._ �_......_.. v r; REPAIR/ADDITION(Prev. Sanitation Permit# ------ ---------------- ------------------ pate --- -••------------•--•-_--) ! l - _� Septic Tank (Specify Requirements) � - ----------------- L7 � - G� �( --- Disposal --Dis osal Field (Specify Requirements) --� � ---------------- � ------------ --- -------------" " •"_--- --- ----------- -- -- ---- l� 0-," Z/3 --------------------------- (Draw existing and required addition on reverse side) 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 Son Joaquin Local Health: District. Home owner or licen- sed agents signature certifies the following: "1 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 Co ensoti n laws of California." Signed c;"T ---------------- Owner By _ _.. __-- -------------------____-.._,_.- Title 4� f -- (If other than owner} FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY . - DATE . .. ... _". ..`.7 BUILDING PERMIT ISSUED ..... r - ADDITION L COMMENTS .._ . r : .....DATE --- ------------ -- aX------ -1---1-_7_v.. ....4- ..... ✓/�S --�-7t_' - - .�d.-f.�. Ux�,�-_-._ ------- ---- - -----------LTi -- I �. - ------- -- ._._....._.. -----• . ------------------------ ----- ----------- ------ - ----- ------- FinalInspection by: ..... �,�c!._._ . bate --------------- EH 13 -6 v• SOON .IO . . UIN LOCAL HEALTH DISTRICT 8/7!i 3M 1 1