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FOR OFFICE USE: Ai 'CATION FOR SANITATION PERMITq I */ Permit No. .7�------------ (Complete In Triplicate) ----------------------------- ---------- P 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 ismadein compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ?A40/.-..�� XCIC—{Ar - --Y '- O '` CENSUS TRACT ---S-S ---- Owner's Name ..._ 4m x D------ /Y W r... ....... - . - - _-...:. - Phoned. .`q/n2�3 012 57-c-- ..... City /1fIV,& To '... .... ------------------------------- Address _._ 41.1---- ��+hC�PF-. $T.... --- ---- - -----.--...License Phone gza- � Contractor's Name .T-XAR ------------------------ �----- Installation will serve: Residence ❑Apartment House[Kommercial []Trailer Court '❑ Motel ❑Other�F�A�E�GLf ��- CF' Number of living units:...-- Number of bedrooms ...Garbage Grinder- ---- Lot Size ...mac-- ��+ ------ W *01 ater 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 --------- ------------------ (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 permittedJLif public sewer is available within 200 feet,) �� Q PACKAGE TREATMENT [ ] SEPTIC TANK Q Sizer J�'L�-X -j� red---�-- Liquid Depth _64---_-.----. Capacity 164#0 ----- Type7/ -. Materia ir.ci4 74 No. Compartments�----------- ----- -- ----� ' -�.O.----- - -- Prop. Line �S_.---- --- �istance to nearest: Well -64)---- O Q--..--..-Foundation " No. of lines � _ .--_.. --- ---- Length of each line_/- ------ - ----- Total Length /$0-- - ------ ------ LEACHING LINE [�} O D' Boxyt-S_. Type Filter Material(Jf oCA� -------Depth Filer Material /?--------------------�---------- --....._ Foundation f�__..-_--.------ Pro er LineS----------------- Distance to nearest: Well -/�.-= 7"- p SEEPAGE PIT [ ] Depth Diameter Number _-----._.._...---_---.-- Rock Filled Yes [INo ❑ Water Table Depth ------- ------- --------- ---------Rock Size ---_------------------ -------- Distance to nearest: Well __..-....__..._.... ..... ---------Foundation --..--_.----... --- Prop. Line ----..--_.---- _. - REPAIR/ADDITION(Prev. Sanitation Permit# -...-...._....._..- ---- -- Date .........------------------------) Septic Tank (Specify Requirements) ------------------------- --------- ------ ------------------------------------------. - - - - 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: even in such manner "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." Signed -- ...-. Owner 9 ------- - - -J� ----------- --- ----- -------- _ By ..._-._ -- p other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- --- -- -------------- DATE .... 7�1, BUILDINGPERMIT ISSUED ---- - ---- -------------------------------------- -------------------------------------------------DATE ------------------- - - ADDITIONAL COMMENTS -- - --- ------------------------.--------------------- ----- ------------ --------- --. ------- - -- - - - - ----------------------- - -- - -- - - ----------- ---------- ---I-- - -- �- FinaInsp - --- --- -� - -�--Dato ...... � SAN JOAQUIN LOCAL HEALTH DISTRICT C u o 1-'AA Rm, rM