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�� 993 �''.t'•w.�„�*t,.�f�. y �^'' �_t- '�'-:_.;�!h:'��.... FOR OFFICE USE: APPLICATION FJR SANITATION PERMIT Permit (Complete In Triplicate) ------- --- ----------------------------------------- .`....................................... 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 descrilned. This opplication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO iON .. t.. 6 f es..- ----------- :-- ...-CENSUS TRACT .......................... f / f Owner's Name ----- --- .....J 1.. �.�7 _�.1. -. ............................ _....... .....Phone ........._...I......................................... Address :............ . .......... ..Z. T _._. .�---- . ... _.. . V--------...._.--. City WF••�-----------•-----......----....._ Contractor's Name ...._. _. . ..6...__. -0 - -- License # 7 ��_..:_. Phone `= , t Installation will serve: Residence partment House❑ Commercial❑Trailer Court C) Motel ❑Other ............................................ Number of living units:..... Number of bedrooms .......Garbage Grinder L- :J --. 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 ❑ Hardpan ❑ Adobe Fill Material/ ..... If yes,type ---------------------------- t_: (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 ize.._4 .�.n_ q Depth -- � p ..................... Liquid De - --� Capacity ........-------- --� ..._ Type No. Compartments P ...... � Distance to nearest: Well _... __'.....................Foundation .� .f....._..... Prop. Line _ _ ��--.._.._... LEACHING LINE [ No. of Lin:__- s ------ Length of ach line.:y , .._....-.> Total Length ,ly_f...._____... j 'D' Box .__ ...._. Type Filter Material �' ..._.Depth Filter Material .. ..:..........................:...I Distance to nearest; Well ..,/./� .......... Foundation ...�! _ .__....._. Property Litre .4?.................... [ � ' Rack Filled Yes PIT Depth ._F��.:...__--- Diameter :..?::?----..__. plumber ...- -----___-�- ;. Water Table Depth f........... [SIEPAGE p .......---•- `� ..................Rock Site ---��--:tf��..f..--•- _ Distance to nearest: Well ...... '.�_.......................Foundation .....f ....... Prop. Line __ _ .......... FREPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ----------- ---•- --•-•--••---• ............----------------------------------- Disposal Field (Specify Requirements) .._ __...--. �____ . ----------------------------------------- ----------------------•----••-------•- --------•---.----------- ............... --------------------------------------------------I....................... -------------...------.......---........................._..--------__.-...--------------------------..:...._...--------•---•---------------•---•-----_-----.-_--.-------_----•-------__....._----------- (Draw existing and required.addition on reverse sidel F1 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 F `as to become subject to Workman's Compensation laws of California." Signed ........... ............... .r. Owner •----- - BY .... . . _ � ..... .Title ---- .. (if of than owner) FOR DEPARTMENT USE ONLY F-APPLICATION ACCEPTED BY ...... ::._G .......... DATE ... _ .. . . ................... BUILDING PERMIT ISSUED ............ -• DATE ... FADDITIONAIL COMMENTS ................................:.........------------ *---------------------------------------------------------------- •......... .:.......... .-------------- . ...... ...............................................• ---------------------------------------------------------- ----......------------------------------ --- ----- ---•- .._..._...._.. ' -------------- --------------- 01Final Inspectionby: .. ... .. -•-- ----•.............. .. . ........ .. •. -•--------.--•• ---.Date . . L..........__...- SAN JOAQUIN LOCAL HEALTH DISTRICT