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FOR OFFICE USE: LICATION FOR SANITATION PER ........ ............ .......... ... ....... Permit No. (Complete in Triplicate} ......I............ .. This Permit Expires 1 Year From Date Issued F Dote Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein F'�escribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ 5 E'_W��iU,._.Q� .�._� -�.�. .Wt.rs�+�..� ..CENSUS TRACT -------------------------- wner's Name ........ .......W. .........---....... ....... ...Phone .................................... �4ddress .-- .---.. ----------- City . .. . .. .. .... _. ... .. _.------------ --- .-•........ ... Contractor's Name �• . ..1 .. 5lE -_ �.�!�------.License # T`-' '- Phone �e_7_____ t Finstallation will serve: Residence ❑Apartment House 0 Commercial �l railer Court EJ i Motel ❑Other ---------------------` r umer of livingunits:.. Number of bedrooms ____..._____Garbo a Grinder .......... . lot Size -� f._ 9 .... ......... C�atebr Supply: Public System and name . • --•-- ------------------------------ ---- - --• . ---_--------- ----- •-- ...--------..Private f Character of soil to a depth of 3 feet. Sand F] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ F 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.) V FVEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT I ] SEPTIC TANK+[ ) Size..._....... _ .. .... . Liquid Depth Capacity Type .�' °� _ Material.. No. Compartments _ Distance to nearest: Well �� r 1---------------...Foundation . &c 6._ - . Prop. line _ '..�_...-.... LEACHING LINENo. of Lines r [ ) f Length of each line .....,��_.. ... . . Total Length I.q'U...... ( 'D' Box Type Filter Material 1�1.... _�_._I -Depth Filter Material ... .............. Distance to nearest: Well ....... Foundation al ............ Property line EEPAGE PIT [ ) Depth a�S ...- -- Diameter --- . �.�.._ Number (. .. .... Rode Filled Yes No Water Table Depth ...... .....................Rock Size .............. Distance to nearest: Well ....-. .!_�` ....4`..................Foundation -.JQ.'_ Prop. Line _., ................ I REPAIR/ADDITION(Prev. Sanitation Permit# ........ _._ ........... Date ...........................-.....) Septic Tank (Specify Requirements) - - - .._,............................:.......... ... Disposal Field {Specify Requirements) ......--•-------------------------------------------.-.-.-...--.-- .. .... . . ............ -- ---- ........ ........ .......... ...... ............. (Draw existing and required addition on reverse side) 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 Iicew ed agents signature certifies the following: �l 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 subject to War an's Compensation laws of California." geed . .. . . .. .. ... . . ... . ........... .................. Owner �y Title kAIV I (If other than owner) i 1' I FOR EPARTMENT USE ONLY � Fj7kPLiCATION ACCEPTED BY . 'I. ... DATE . )`. .Z..... BUILDING PERMIT ISSUED :. - :-.. _ ............... .... ..... .. .. DATE _............_. ADDITIONAL COMMENTS .. ... . ..... . .. .... . ........ ..... :.........._....... t - ................./- ---. .- _ ... ... __. --.......... ............ ....... .......... ........... ..... ............................................... ..._.. ..................... . ...---- ...._..- inal Inspection 6y: = Date . � �----------•-•------- SAN JOAQUIN LOCAL HEALTH DISTRICT +�