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- FOR OFFICE USE: -- >0?–/7 ; rPPLICATION FOR 'SANITATION PEr 'T ...... ........ kd �Oi (Complete.in Triplicate) Permit o. .. ................. - ....._........_.....__..._..........._......_.... This Permit Ezphes 1'Yaec From Date Issued ' Date Issued __/:�.-.`.!'.:!- 0 / Application is hereby m6de.to the Son Joaquin Local Health Distfict..for a perrnit'to.Constructand install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRFSS/LOCATION ... ... .....CENSUS TRACT .......................... Owner's Name .........9./D.......A.[.5 A.S.r..•._... _. _._-��..... ..._.................................................Phone.................................... Address 01. .... ......T.RCA vRE..... .�•< . , .:..... ._........city ....S.r.o...ckT_oN.......................................... Contractor's Name ...1d'ES........s'E/4'TLf...:S,1/(4 i e,67........._License# 1.7?_V.T.3... Phone Installation will serve: Residence❑Apartment Housb aCommercial ❑Trailer Court ❑ Mn1el❑Other . . .:._:__.. ............ Number of living units:. .......... Number of bedrooms ......... Grinder ............ Lot Size ................................. Water Supply: Public System and name ................................... .._...__......._........_.........................................Private La— Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑. Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe,R� f8 Mater.... .... ....... 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 pertnjftd if peblic sewer is available within 200 feet,( ALN PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Site.:................................... ._.----- Liquid Depth .......................... �j Capacity .................... Type ....:..........,..�Material...................... No. Compartments ...................... Distance to nearest: Well .... .:..... .. ....................Foundation ... .................. Prop. Line...................... I , ..... . Q�jl _ . ._. _ Total Length [ ] D' Box .... Type Filter Material ......-? . ......De __.......•.............•.- LEACHING LINE No. of Lines . ......... . Length qf,e line,. �P {��t r Material ..........................._.........._... Distance to nearest: Well ._. _ Fout dation ___ ............._.. Property Line .........._............ SEEPAGE PIT [ J Depth ... .._..... ...... Diameter _.............. Number ... .. ..................... Rock Filled Yes ❑ No Water Table Depth _............ .................................Rock Size _............._......-_...... Distance to nearest: Well _.....:... ............ ..............Foundation .................... Prop. Line ...................... \n REPAIR/ADDITION(Prev. Sanitation Permit# ......... ..._. ... . . .. . ._.. . ... Date .................................1 Septic Tank (Specify Requirements) . ... ........ .__ ... ..__. . ... . .� Disposal oield (Specify Requirements( aZ. .x 33...... �1'S„ ........ ..............---. .__......._.._........._...... .. ..._..... .............._ . ....._ ................................_..................... _..............I................... .... (Draw existing and required oddition 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: .; - "1 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 becom �subject fe erkm 's Compensation lavrs of Colifernio." SignedOwner . Titlo .._._. . ......_ (If other than owner) OR'DEPA#T1dENT USE ONLY _APP—LICATI 014 ACCEPTED BY - - ..._. DATE ._42- BUILDING PER?AIT ISSUED . _.. ._. _ ,.r.. ._ .. _. ._..... ..........DATE ._.__.. .. _. . ..___.. ADDITIONAL COMMENTS _. _ _ .... ._._ _. ..: 'r..._...._ – _ _.. __ ___....__... . . ....... _.. . ._._.. _ ....... -. ..........__ _7 F nol Inspect on by: . !r�. C ..C. SAN JOAOUIN LOCAL HEALTH DISTRICT F. if. 7 1-'S8 Rev. 5M s