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APf'LILA iON FOP, SANIT TICK PERMIT S 3 ._ (Complete in Tri-plicafe) Permit No, This Permit Expires 1 Year From hate issued Date Issued .. 7. Application is hereby made to the San Joaquin Local Health District for rs permit to construct and install' the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: .� JOB ADDRESS/LOCA'rfOP'.;.,:.1.. :'-- -.... ... -. �,ce c�. 1�✓� CENSUS TRACT Owner's ?JamePhone Address ... ......... . ... Address _ ....... City,_d��_e .r Contractor's Name ---- . /. 2.:..............License # f .j -.. . Phone ..., .. . - r.... Installation will serve: Residence EaApartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other .......... _ -- - Number of living units: . .-/----- Number of bedrooms _3_ ......._Garbage Grinder .. . ...... Lot Size ........... .. ........ ......... Water Supply: Public System and name -- -------- ...Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam (❑ Clay Loam [j- Hardpan Hardpan �/ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT - � j � [ ) SEP1)CTANiC[/� �, Size_:�/.:�....!'_.1..:.-r...-`.�............._ Liquid Depth ..�./.................... � i �--` . No. Compartments ' _ Capacity t'.7->ftj. Type _..__ Material.: L� :___. Distance to nearest: Well ----.._.__�..Q.................Found'ation ......1..V?-- ---._ Prop. Line ... ..�.........� LEACHING LINE [i] No. of Lines - ------------ Length of each line-... .. ...... Total Length ...1. 'f°.. ........0 'D' Box .....! .... Type Filter Material _.. lY '.._._..Depth Filter Material _ l..'%_..[.............................1J r / Distance to nearest: Well ......: r:`..�t... Foundation ....%.i'_f"�.._. Property Line ...._s .�.......... CA SEEPAGE PIT Depth .._- .. _ Diameter ...._�_3'.�_ Number ............ ........... Rock Filled Yes []�No I❑ -� , j ( r Water Table Depth -----------/..E? '.• -------- ---._-..--._._Rock Size --- -.a/ .---- .. ......_.. All Distance to nearest: Well ..........1.ISJ- 3._/-.:_--_..--___foundation _.�- - ._-- Prop. Line :S~...._......_ REPAIR/ADDITION(Prev. Sanitation Permit q� -------- ----------------------------------- Date .........---------..---.--..---.--) Septic Tank (Specify Requirements) -------- - -----------------•----•---•-• ----------- -------------- ... ...... ........... Disposal Field (Specify Requirements) ----------------------------------------------------------- ... _ - ------------------------------------------------ -- - - - - --- ---- - ------- D raw -- --Draw existing and required addition on reverse side) 1 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 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 shell) not employ any person in such manner -- as to become subject to Workman's Compensation laws of California," Signed _ - --------- Owner Bv �� [- s Title x:l (if other than owner) FOR DEPARTMEN1 USE ONLY r, APPLICATION ACCEPTED BY C ...... ------- DATE C BUILDING PERMIT ISSUED _ ADDITIONAL COMMENTS ....... . Final b Inspection '' y: Dme 3.i�f !