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FOP OFFICE USE. APPLICATION FOR SANITA?€Oil PERMR' (Complete in Triplicate) Gate This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the -,,ork herein described. This application is made in compliance with County Ordinance No. 549 and existing Ruzvj; and Regulations: /t JOB ADDRESS/LOCATION L. .l'___ _.__: ` _ _CENS�SCT __._.__._.__.t � �� /7� ----------- oo Owner's Name J Address ��€ `�� f - * <.. f?_. yl _. City 1Y 1---- ---- --------------- _ _ Contractor's Name ----- ��- ----= e'(r L. -I ,ty--------------------------- License # -- _ Phone . +-_ _ Installation will serve: Residence [G <partment House❑ Commercial ❑Trailer Court ;❑ _ Motel ❑ Other - ----------------------------------------- Number of bedrooms �___-___ g /�_. f /` 4' L`t.._..--_... Number of living units:__ .___. - _� Garbage Grinder ___�L.'__ 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 __ ___ _____..____.______ (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 P4Size.__ __ �1' _ Liquid Depth Capaaty �f _._ Type > MaterialNo. Compartments �.. �+ aDistance to nearest: Well . ��'~1J- - .._.. _ Prop. Line ______________________ •*� - -- --Foundation -f- -- - ---- _ - LEACHING LINE No. of Lines _..s7`'..__-_ _ Length of each line._r/e%'C_`!...... Total Length �4`. 'D' Box h=✓. Type Filter Material/_ Cf Depth Filter Material ,, f�______ _________________ _ Distance to nearest: Well _ XC'------------ Foundation -------------- Property Line _ ._.-_.___..._______ SEEPAGE PIT Depth -11- 1Diameter ____"__ ____._ Number __________________ _________ Rock Filled Yes � No ❑ t -J fp Water Table Depth -.-.-----j7=�3 ---------------------- .--Rock Size . `------------------------- - Distance to nearest: Well 11-1/1 25!. --------------- ____Foundation ----76........_ Prop. Line z.-________ REPAIR/ADDITION(Prev. Sanitation Permit# -------- - ---- ----------- - ------- _ Date ------..__-________________. j Septic Tank (Specify Requirements) _---------- ----------- -. - - --- --------- --------- Disposal Field (Specify Requirements) ------------- -- ---- -- -------- ----- - - - ------ - ------------ - -- ---- -- - - ---- -- - -- - - - ..._..--- _ _ 1 (Draw existing and required addition on reverse side) C I hereby certify that I have prepared this application and that the work will be done in accordance with Sane 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 p-arson in such Manner as to become subject to Workman's Comp t cation laws of California." Signed - - - - Owner By -- Title - -- -- ------------------ on- - (I er thowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�. __.._. DATE 117e �:4_e______________________ BUILDING PERMIT ISSUED -- ----- - ----- ---- ------------------------------------------------------------DATE ------------- ------ -------- ADDITIONAL COMMENTS ------------------------------------------- - --------------------------------------- --- ----- -- ------------------------------------------- --------- ----------------------------------------------------------------------------- ------- ----------- ---------- ----- ----------------- -------- ---------------- --------^-------------- ------------------------------------------------------------- ------------------------ k-- - ------ _ Final Inspection bv: ._. _ Dat __. ---- SAN JOAQUIN, LOCAL HEALTH DISTRICT E. H. 9 1.'68 Rev. 5M