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` FOR OFFtE-USF-- ( ,PLICATION FOR SANITATION PI:R f Permit No. -- --5- --- -----------------------------------• ------------ (Complete in Triplicate) ---- Date issued fThis Permit Expires 1 Year From Date Issued Application is hereby made to the San oaquin Local Health District for a permit to construct and-,install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 170 00 k"11i JOB ADDRESS/LOCATION f ` ------------------ ---------- C r ` 7`t A- ------- I-Z-----•-- -- - I� CENSUS 'TRACT +--- -. Owner's Name A (�:-_Zl ----- -.'_�.. Pho y Address -------------- rte, - Cit P- -R N_-----•----(--k- ------------- Contractor's Name ----_" __-- 1 License #/ 1� Phone .. -llJ�I�� -•1 Installation will serve:. Residence ❑Apartment House❑ Commercial :❑Tr ilei•Court ;❑ Motel E]Other ---------- / Number of living units-------------- Number of bedrooms ___."_" =:Garbo e, Grinder -"" _"." Lot Size ". "_-- --_ -- ----•-- Water Supply: Public System and name __:=----.--"-- ----------- Private Character of soil to a depth of 3 feet: ,; Sand/ Silt❑ Clay ❑ ` Peat❑ Sandy Loam ❑ Ciay Loam ❑ Y Hardpan E] Adobe E] Fill M t rial ------ ----- if yes,type --------- (Plot plan, showing size of lot, location-of system in relation to well, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank o,r,seepage pit permitted if public sewer is available within 200 feet,) Z ,` `. Q PACKAGE TREATMENT SEPTIC TANK'[ ] Size"_� .�� - - ----- ------ Liquid, Depth.`.._--- ____1---------.---------- CapacitylZ.Q�"-_---- Typed - Materia ._- No. Compartments --Z---- - ---- O r Distance to nearest: Well -------------- -"----'Fouridation _"1.0.--- Prop. Line -----•--•- ! Total Length P LEACHING LINE No. of Lines Length of eac li ....: (x---------- 9�� �' j t`arr a th Filter Material D' Box a Filter Material .1 - ---- ---. p .......... Type r r Distance to nearest: Well -J�-------- Foundation _119------------ -- Property Line. -/-. ----= :•- SEEPAGE PIT [ j Depth --- Diameter ---------------- Number - ------ Rock Tilled Yes ❑ No Water Table Depth ---- ------- ---=--------Rock Size -------•--------------------- Distance to nearest: Well _.--------------------_ 6-------------------- Prop: Lime .--------------•-••--- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---•----------------------- -----1 _�eptic 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. Nome owner,or licen- sed agents signature certifies the following: "I certify that ' the performance of the rk for which this permit is issued, I shalt not employ any person in such manner as to becom su ject to Wor an' Com ensation laws of California." Signe --- - -------- Title Own aTitle - ~----------------- ---------------------------------- By -/t - - - ----------------------------- - fother than owner) FOR DEPARTMENT USE ONLY - DATE . -` --- ✓._".. 1..----•...... APPLICATION ACCEPTED BY _... ' — -----------------•----- -------------------------------- BUILDING PERMIT ISSUED ------------------ -- -- - -----DATE -----'---------�-------- ------- - ----- ADDITIONAL COMMENTS -------y-: -.._ _ ------------ -------------------------------------- -.".. . ,-s ; y f re ------------------ --------------------;4/_D `� f ate • .: rte Final fns ection SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M