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{ FOR OFFICE USE: rf PLICATION FL � SANITATION PEEP 2 (Complete in Triplicate) Permit No ______________________ 73 ---------------- 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 No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION /� --__--CENSUS TRACT Owner's Name ------ •----- Q-s -� Phone ----------- ---------------------- Address CityC-l�. -�t�------------- Contractor's Name _ --_ d / _ ---License # -=-X3_11 .3 Phone _`7` �� Installation will serve: Residence ❑ Apartment House-E] Commercial ❑Trailer Court ❑ I Motel El Other _' .cQt c� Number of living units:---1.------ Number of bedrooms _ _lGarbage Grinder _.---------- Lot Size __--5 71r'_ Water Supply: Public System and name _________________________________ - _- -_ Private)< -------------------------------------- ----------- - - Character of soil to a depth of 3 feet: Sand'❑ Silt E3 Clay-❑ Peat E] Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe)>4_,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°{ ] Size___-- -r---- r' �+ -----•-- ---- Liquid Depth --- .�`�,.----••--- _ _ No. Compartments _ Capacity --f�-$-G'�Q------ Type Material__L-�tJ_�_�'�i-b'r r Distance to nearest: Well ------/0Q---------_---__-__Foundation ____ Prop. Line .-_ LEACHING LINE [ J No. of Lines ______ __-_____---__ Length of a line_---._�i_ ..._____- Total Length ,_�. ------ - S 'D' Box A*Ype Filter Material __/! '"Depth Filter Material -------- ._ - Distance to nearest: Well ---_ ---- Foundation -----��--�---- ----- Property Line, ------- -••------=---- SEEPAGE PIT [ ) Depth _-c::2_S ------- Diameter —3.3---- Number ------- __ / _ Rock Filled Yes No .C] Water Table Depth ____ r ------_-----------Rock Size -� 2-X l �---- Distance to nearest: Well _____ •,�� ------------------Foundation __Z_0-___T-___. Prop. Line ----- ------- REPAIR./ADDITION(Prev. Sanitation Permit# - ----------------------------------------- Date -------------------•--------•__---} Septic 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. 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 person in such manner as to become,&d126ct to or an's Compe ati.on laws of California," Signed ---- ---- Owner BY ---------------------------- --- Title _. (If other than wner) 1F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE ---- �3- •------------------ --- -- --- -- BUILDING PERMIT ISSUED _ -, ---------- ------------------------------------------------- ADDITIONAL - ADDITIONAL COMMENTS ---- L. - -------------DATE -- - ------------------------ 1, ---------------- i i ----------------------- ------- ----------- -------------------------------------------------------------------------------- ------------------------------------------ --------- -- ---- - --- ----------------------------------- ---------------------------------------------- ------ --- -- -; Final Ins ection b -=------. p Y -r Date --- ---- -- -- - - -- - - -- -- - -- SA JOAQUIN LOCAL HEALTH DISTRICT