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FOR OFFICE USE: `APPLICATION FOR SANITATION PEWIT 1 h (Complete in Triplicate) Permit This Permit Expires t Year From Date Issued Date Issued 9_7n1S— 3 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. Thisfpplica tion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/ ON _ _.�. �. . - - TRACT ....... -�y ------ -- ---------- - - --- ---- - _ �-CENSUS R Owner's Name ..... .' ... . _ Phone ------ ---------- - Address .--------Ia.� - -- --------------- ` • Ci' -- L ------------------------ Contractor's Name .----- : - • -- ----- ----" --...._... cense # Phone Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court fl Motel ❑Other --- ------------------_---- --------------- Number of living units:..._( _... Number of bedrooms ------_Garbage Grinder .._. ------- Lot Size ---- ----- --------vim"-=---- Water Supply: Public System and name -------------------------------------- ------------------ .....Private Character of soil to a depth of 3 feet: Sand❑ tlt 0 Clay [I Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan [KAddbe❑ 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 seege pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT 1 / 17 SEPTI TANK q - n � .Sizes'-.. �4.---X... ......... ...... Liquid Depth --- - - •--------••---- Capacity _b _g Type -_ Material..._ � No. Compartments ��---- Distance t nearest: Well _._.._..rte©._--.__--`Z-_Foundation ...�p............. Prop. Line _._s-_....__.. LEACHING LINE No. of Lines / -.�-------. Length of each line_._.._ _�a.__..._._... Total Length ....._/r?-o___ � D Box ----- -_.- Type Filter Material .....__c5.____..Depth Filter Material .. _ I - �f---- -------•----�----- Oa Distance to nearest: Well .._._.Sa_- ------ Foundation ..__.._L._d_._____. Property Line ...------- r SEEPAGE PIT Depth Diameter w g ---- P ---- -- - - - - ._3.z✓...___ Number .._._____sal_ ._.____. Rock Filled Yes No ❑ Water Table Depth ----------__c r' m ----------------_-__ ---Rock Size Distance to nearest: Well --------1-p 0---------------------Foundation ..../..27 c� --------- Prop. Line .....----------------- REPAIR/ADDITION(Prev. Sanitation Permit# ..------.----------------------------------- Date _ --------- ------ __.__.-__-----) Septic Tank (Specify Requirements) _.._____._.-_--_ Disposal Field (Specify Requirements) T� ..---------------------------- raw existing and required addition on reverse side) I hereby certify that 1 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: "1 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 Work Compensation laws of California." ■ Signed .__---- -- ------- --- - Owner - ------ - - - ------ By - �--�Yi.. t Title _. Lrt�LR2C (If other than owner) FOR DEPARTMENT USE ONLY _APPLICATION ACCEPTED BY_. ................ DATE ..�.' �.--? BUILDING PERMIT ISSUED.---------- DATE --------------------- m ----- ADDITIONAL COMMENTS ....._...._ ...-_- ---------. .... - ------------------- -----------------------------------------------------•-------------------------------- ------- ----- - . ------ R Final Inspection by: ..--- -----------------------Date y - ------- J LSAN JOAQUIN LOCAL HEALTH DISTRICT