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LPermit FFICE USE: FOR OFFICE USE, pLICATION FOR SANITATION PERMIT o.7B' � ------.--•-•--••••--._........ (Complete in Triplicatel, ued.`Q This Permit Expires 1 Year From Da Issued Application is hereby made to the San Joaquin uncalOHred1�th District 549 and existermit ing constructuI and Regulations: work herein described. P This application is made in compliance with County r _ 2- e. ._... - ..CENSUS TRACT - JOB ADDRESS/LOC2 - Phone . •--....---•-- Owner's Name. _ - --- zi ,�' - r `� Address-..__ - -- •-------- --------•--.... _... _ ` � .............�•3 Contractor's Name-------- - _ / . - ---�-License #,.. m ,�2/ one _..... Installation will serve: Residence -Apartment House ❑ Commercial ❑ Trailer Court ❑ • Motel ❑ Other................. ` f Number of loving units:................Nursiber ofbedrooms_- ____.Garbage Grind�__...._•..:_Lot Size._..----.---•••------- NPrivate e- --------------- ----- •-- = _`------------------------------------•--••••-•---•• ------- ------Water Supply: Public System and name-•--------------- - Sand Loam Clay Loam ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat:❑'' Y '®� Hardpan ❑ Adobe ❑ � Fit! MoterioL_.----------! :yes,type--------------•---- - to wells, buildings, etc. must - (Plot plan, showing size of lot, location of system in relation be placed on reverse side.} NEW INSTALLATION: (No*septic tank or seepage pit permitted if public sewer is available within 200 feet,) V i Siie_ ... - j 4-- -- -- ---------------------Liquid Depth---------------------------- . TREATMENT I ] SEPTIC TANK I ] 1) Capacity Type_-- Material".......................No. Compartments................................... Distance to nearest: Well.-__..:.....-,--------- -----------L LFoundation----_---..............=-Prop. Line___.---------------------- Distance _..-_-.-_ -. ----- No. of Lines--:•----t-------•- .•-•--Length of each lin;'-----------=_---::..._.-Total Length•_....... ------------------ LEACHING -•--------•-----LEACHING LINE ( ]. F 'D' Box ----------TYPe Filter Material.._--- ------- Depth Filter Moterial ,: -; Distance to nearest. Well..-•-•.- - ..Foundation-------•---•----=----------Pr�rty Line--------_--- ---- De Depth Dia►neter - umber. ------ - Rock Filled Yes❑ No❑ SEEPAGE PIT ( ] P r Water Table Depth--- ._.�_. ..... -Rock Siu---------------- -------------- Foun-dation._ Prop. Line---------- ------------ Distarice�to nearest:Well__..____:........- •;-----••- F --_-- -...Date----------- _----•------- •-•-] _........... REPAIR/ADDITION (Prev. Sanitation Permit#.........:.. __ �� a Septic Tank (Specify Requirements)_._- . �-- /� Disposal Field (Specify Requirements):-... •••- vL-;. +��- .� t y ' l __..... t ---------------------------------------------- ..... .. . .................... ------- ......--••••---- - - r t _ (Draw 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-thea San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: W eertify that in the performance of.the.work for which this permit is issued, I shall riot employ any person in such manner as to become subieci to .Workms Compensation laws of California." Signed.. - __--.-.---•--- ..............................Owner y..................................r -----------:Title.- ---------- ,�.f' t BY; . ._- - ({ other that► owner} FOR DEPARTMENT USE ONLY- . 1611 APPLICATION ACCEPTED BY:' ------------------------_------- DATE DIVISIONOF LAND NUMBER-------- -- - ............... ---------:•:-----•--------•---------.•......_.DATE -------------------------------- ----•----- --- >DDITIONAL COMMENTS............................. -------------.......------•--------•-----.....---•--------......---..... ... _ - - -------------•-----•---..:-.__......•..........----._.•.....•---•-•---------------•----------- --..- - ----•--•-•----••-•......•.....•.............._.._----..... U .... r� :..._..... - --- 0 Final Inspection by:... FSS 21677 REV. 7/746 3M FH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT