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FOR OFFICE USE: - i�PLICATION FOR SANITATION PUP, -) � ............................... w (Complete in Triplicate) Permit No. .. . ..`. .q.. ----------------- 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 is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: C JOB ADDRESS/LOCATION ........ 1�'y.-•--L. d.............................................-..CENSUS TRACT ....].""--.---- ...... Owner's Name ..............Z.,::. ....... 5......... Phone ... .................................. Address ---, ............................................ City ......... . :..._.... Contractor's Name .License # ........ Phone Installation will serve: Residence ❑Apartment House 0 Commercial Xyrailer Court 0 Motel ❑Other ---------•----------- ...................... Number of living units_____________ Number of bedrooms ............Garbage Grinder ------------ Lot Size .........................I................. VQ Water Supply: Public System and name ---------------------------------------------------•----._........._......-•----•-•...--•----------•--..__._..Private Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 0 ; Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ........................... {Piot plan, showing size of lot, location of. system 'n relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT SEPTIC TANK Size... .. ) � �A--.l...X.7....._...---•--...... Liquid Depth .................. Ca acity ../foQ.----- Type 44'--SAgMaterial...... E�°!vG.: No. Compartments --- ..............� istonce to nearest: Well ....................................Foundation ...................... Prop. Line ........................ LEACHING LINE No. of Lines ...... .............. Length of each line.__._- �a..___..._.._- Total Length ...... 'D' Box ..../...... Type Filter Material ...Yk_.........Depth Filter Material _....... _ .........t............. Distance to nearest: Well .....f- Q.'± Foundation ..... Property Line ��... ...... . SEEPAGE PIT [ ] Depth .................... Diameter ................ Number ........................ Rock Filled Yes ❑ No ❑ Water Table Depth .....................Rock Size Distance to nearest: Well ---------...............................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev, Sanitation Permit# ................................... ... Date ............................... SepticTank (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 Lows, 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ....-..... - Owner i - By .......... .... ................ ..... title ........................................................................ (if other than FOR DEPARTMENT USE ONLY 741 APPLICATION ACCEPTED BY _...... . ..`. .......................................••---•-------.......................• DATE ....... ...`�- ..... BUILDING PERMIT ISSUED ........................... .......DATE ADDITIONAL COMMENTS .....--•.............................................:......... --•--------------... .. .:._.... ..a . ;�f---•--.._...............------.................. .... ............................. '�� - --- -- -- -- . . .......Final Inspection by - -1 � /� d--- --._ .................... Date SAN JOAQUIN LOCAL HEALTH DISTRICT c Lr 13 24 1_,,&a o— KAA 7172 3 M