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FOR OFFICE USE: 1� !CATION FOR SANITATiON PERK w {Complete in Triplicate} Permit No, This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loco[ 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/LOCATIO lam/ CENSUS TRACT ... N . .. J' S . � ..�� Owner's Name .. ... - - L, -- - '.. %..- - ..... _ . . -......._... ......._.Phone ........ - ------------------ . ...............�. . Address .... ....:.. ........ .... ......... . City . ...._ . .._..-_ ----- ---- Contractor's Name .. . . -- .. -. �. .. ......... . '��......License Phone :"?047._.__ Installation will serve: Residence [] Apartment House 0 Commercial railer Court Motel ❑ Other _ T\ Number:of living units: . . ... Number of bedrooms ..._-.__Garbage Grinder .... ... Lot Size 1% Water Supply: Public System and name ------------- ---.........---..Private Character of soli to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy loam Clay Loam ❑ Hardpan ❑ Adobe 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.... ._..._.t-r _ •.._ Liquid Depth .. .>'?r...._... Capacity { � 2 .Type 41Zf - 4'. Material.-`� 'arr Q No. Compartments ............... Distance to nearest: Well .�.3r�a `,.75... . .. .......Foundation . 1�;.`.6- . Prop. Line _JL'..F`_..-. Z LEACHING LiNE [ ] No, of Lines ... Length of each line Total Length ..�.�C�`- .......... 'D' Boz ..... Type Filter Material .t -Depth Filter Material / '.��... ..-.,_...•-.. - Distance to nearest: Well o'er ---- Foundation Eco-`.�?`..-... Property Line ' ""*. SEEPAGE PIT [ ) Depth 5 �.._. . Diameter --x _ _.�..- Number ( Rock Filled Yes No CD Water Table Depth -...,`.'�`_� --------------- ------._Rock Size ...... ti i� - .............. to nearest: Well . ......}. t......._. _-_._.Foundation ....tC.'f� ... . Prop. Line .._... REPAIR/ADDITION LPrev. Sanitation Permit# -------- ... --.- Date ...• ............... Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .............. ...... _ ............ .............. ----- ----- ...... (Drdw 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 tliis permit is issued, I shall not employ any person in such manner as to become subject to Wer an's Compensation laws of California." Signed . . . . ' . .. . .. . ... .. . p Owner Title By - ............... .... (1{ other than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY11 DATE .. BUILDING PERMIT ISSUED .... DATE ADDITIONAL. COMMENTS .— ............ ..... . .. .... .......... .......... ....... ............ FinaInspection by: . V!,------ _ . . r.. ... ............... - .Dae . . ,? . ................... SAN JOAQUIN LOCAL -HEALTH DISTRICT 13 24 1.,An