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u �yirLICATION FOR SANITATION PER--,,' (Complete in Triplicate) Permit No, ._._ . ------------ This Permit Expires 1 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 Qrd'nance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .1_=f.=' - •�='rf_.�:- .. �-L.a_ --- - �^tp� lslrl�cc .�'-I,:..CENSUS TRACT Owner's Name . .rr,... t,_ ..Phone Address f � = -------. Cit /Jit -1�,+ �t - - v _..._ Contractor's Name 4-et*>>. ----------------- ------------ .... Incense # . ......... --- .. Phone -------- Installation will serve: Residence ❑Apartment House ❑ Commercial ❑Trailer CaMt 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 El Clay ❑ Peat [_1 Sandy Loam E] Clay Loam PJ Hardpan;E 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 ( ] SEPTIC TANK Size..y_ f.��- rSL...._ ______ _______ Liquid Depth ..'.........------... Capacity /,2-_p n- ..---- Type`v _x',117"_ Material.. ----------- No. Compartments -z------------------ ;, Distance to nearest: Well __7,F_` _______________________Foundation _�-D �- __ Prop. Line _%..J.._._.._....... W LEACHING LINE [x] No. of Lines v�------- - ---------- Length of each line S"4),-- _ -- __ Total Length .................... 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ..... ............_.._...._.._-__..._..-- Distance to nearest: Well 7 s*------------ Foundation Property Line �r- SEEPAGE PIT ] Depth _S - Diameter ----------- Number - Rock Filled Yes No i❑ Water Table Depth __ -.d-----------------------------------Rock Size 14--__ " ------------------- _ Distance to nearest: Well -/_yQ_�._____..________.____-.Foundation _.f..r�..J.. ....... Prop. Line -- --------- REPAIR/ADDITION (Prev. Sanitation Permit# -------- -- - _ - .. .....------------- Date __-__-- --___.___.__.._) Septic Tank (Specify Requirements) ---------- -------------- ------ - ..... Rp Disposal 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 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 become subject to Workman's,Compensation aws of California." +'� . y 5 geed __...:....uta-�Y. .. . h-' . --------•------------- - Owner By .............. .. .. ... - ... -- ----... - -------------------- Title ------ _ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .'�'r.t. trA:c!' - ----------- --- ----- DATE BUILDING PERMIT ISSUED ........ . . --- --- - --------DATE ----- - ---- ----- - ---- ---- ----...__. ADDMONAL COMMENTS . . _ .._ . - - - - -- r -_. - l Final Inspection by: ',..!r - Date f1,= t - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'VB Rev. 5M