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• \/ :.. � V ,err FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT q ..... Permit No�,I. (Complete in Tripticatel ..... Date Issued.,! This Permit Expires 1 Year From Dab Issued - �1 Application it hereby made to.the San Joaquin Local Health District for o 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......lgao. ..... ... Z CENSUS TRACT...... Owner's Name ...Si:,B ._l.TIAS�QSl. ..... ...../.y...�......... . . .. . . . .... C. .:... : .Phone. .......,p Address. . ../Q�:>ZQ . .�✓�¢<.....IxriL!/iQ ... TJ............ .. _ .. City.c�Y!?Lt[1St. ......... . ... ..ZipY t.. Contractor'r Name...trF.ccT.�f� /F.�,��arr/,sr_[p.... ....... . .. .Licentie ^32S [l.irlu . .Phone... .. Installation will serve: •ResidencelA Apartment House❑ Commercial'❑ Trailer Court ❑ k Motel ❑ Other.... . ... ... : ............t.......... Number of livingunits:....,. .... Number of bedrooms... . g X .................. s>Z Garbe a G[inder..�9r1l1.Lot Size .nl..�. ��V . Water Supply: Public System and name.. ................ ..................... ... _. Private N4ti ................. .............................. !i.7 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay❑ Poor❑ Sandy Laorr.�-- Clay Loam❑ Hardpan❑ Adobe❑ Fill Material . ... .11 yes,type.......................... . . a x } , i (Plot plan, showing size of lot, location of system in relation to wells,buildings,etc.must be placed on reverse side.1 .. ta• NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) '• .PACKAGE TREATMENT I 1 SEPTIC TANK I ] Size....... ..... ...........................................Liquid Depth " Capacity. ....I .... . ......Typo................ .....Motorial................,.........No. Compartments........ - ... ` Distance to nearest: Well.......... ........ .Foundation....... . . ........ . Prop. Line t.. LEACHING LINE ..... ( ] No. of Lines ... ...................Length of each line...... .... .... :... .. Total length ........ *4 'D' Box_. . ..Type Filter Material... .. . .... .... Depth Filter Material.. ...................... ..................................... r, CC i Distance to nearest:Well.................... ...... Foundation............. ..............Property Line......................... ... . SEEPAGE PIT -I ] Depth... ..... .__Diameter....................Number . ......... ................. Rock Filled Yes❑ . No Water Table Depth.........................................................Rock Size.. . . . ......... ..................... \.. r:,stance to nearest:Well. ....... ... .... .F&mdation.. . . . ..... .. ....Prop, Line `11 r REPAIR/ADDITION (Prov. Sanitation Per" ..-/..Dote � l .. IJ...........I�. ...-:Requirm ........ j _ .....Septic Tank (Specify ' Disposal Field (Specify Requirements).:.. ............................... ...... ... ........................................... ...... ......... .. ... ......................... .... .......... ............. ' �.��.......�f� UNE... riJ,. ........ J�eYt`iia (DIOW existing and required addMcn on reverse side) ,r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County :.S'?'i.. Ordinances, Stab Laws, and Rules and Regulations of the San Joaquin LRacil Health District, Home owner or licensed agents signature certifies the foilowingt "I certify that in the pedormonce of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to orkman's Compensation lows of California.". Signed...... -OwnC:a'aR�1� @i Ilf oche owne ? _ R EPART _ENT APPLICATION ACCEPTED BY... �,! 's'r•-� `^^ -----DATE ._ - -• DIVISION OF LAND NUMBER -_ DATE .. .. .... _. _. s`I ADDITIONAL COMMENTS. ..... .. " `-' - - .. -.. ..... . . .. .. .... . .. ..__ _ 'tc __ .... _... `�.,\ . ___................ . . .... _. ._ _..._._........... . ._. .. ..... . J7.7n, _ .. . .. .. . . .. . . .. ......Date ....7 1 ..... .... Final Inspection by: . ._ ..... ... . . ... .... .•. 5. .. to a 24 SAN JOAQUIN'LOCAL HEALTH DI§TRICT ` ru.:en stv.1176 sM