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' 0P144' rO R SANITATION P"IT 7S o . .. .1.. ..ermit N .......:........ Imp to in Triplicate? ........... ••..... ......... This Permit Expires I Year From Date issued 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 Ordinoncp No. 549 and existing Rules and, Regulations, f ..............CENSUS TRACT .. JOB ADDRESS/LOC Owner's Name .. '�:. .................... .f. , ..._........ 7. Phone / .....��X rA.... Address ... . ......... . �.... %.. � �C�.;=�.- :,V(. ."-•.-..... City ��..................... ... L ... /� �.. Phone �� Contractor's Name -:-.`' ....� ....................................License ...... •- installation will serve, ResidenceN�Apartment House Commercial OTrallw Court ❑ ° Motel ❑Other Number of livingunits:..., Number of bedrooms. ..._Garbage Grinder ............ Lot Size . ••----••• Water Supply: blic System and name -------------------------------------------------------_..................................................Private)< Character of soil to a de th of 3 feet: Sando SlItO Clay Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe 0 Fill Material ............If yes,type ............... ............ !Plot la showing size of lot location of system in relation to wells, buildings, etc. must be placed on reverse side. plan, • ! e Y NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 300 feet,) jPACKAGE TREATMENT ( ] SEPTIC TANK rn(J Size.. .X �..................... Liquid Depth ... .........••..••••-• F / Capacity l.&0-0..... Ty - ._.. Material.......- No. Compartments ... ---.... . ,Distance to nearest: Well .........................Foundation ...,221— ......_ Prop. Line .J... r _EACHING LINE [4"" No. of Lines ,�................ Length of e Ilea ."' .... Total Length ..1,2e......... 'D' Box - ........ Type Filter Materlailly/. a..C-R-Depth Filter Material . .IQ........ ... Distance to neart: Well � ...........7. foundation /0............... Property Line SEEPAGE PIT [ Depth .. ...,.. Diameter .33....... Number ....,..... .... .... Rock Filled Yes No for .. Water Table Depth C • . G'12.. Rock Size .. .. ......... ..... Distance to nearest: Well _.yl� 4:�9.....................Foundation . „ �........ Prop. Line ... ...••-•- REPAIR/ADDITION[Prey. Sanitation Permit# ............................................ Date ................................ .) k = Septic Tank {Specify Requirements) ........................................... -•--•----..--......... . .»,.....,......................_..........................., Disoosal field (Specify Requirements' ....................................................... ........ ... + . . ..................... ........................................................................ -- ...................................._................................................................ _............................................................................................ (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 taws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ikon, sed agents signature certifies the following: F "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 bec a b•. ct to rkma 's Compensation laws of California." .... Owner ;•gnec' ... ............. . .... ... _ ............._............................. By .. _ ... P -4 .,. � Title .t........... Of other than owner) FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED BY ...... DATE ! BUILDING PERMIT 15SUED ...... ......................................... .......... ... ................ .... .............. ............... ...� --............................----•-............................. .......... I.. J . .- ...Date _.�' .......... Final Inspection by:,.... ....... . .. ....... �}-•-.................--..... �. Di Y3 2a 1-6ii 1 ev, qi SAN JOAQUIN LOCAL HEALTH DISTRICT !t 3M