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FOR OFFICE USE: ,�PPLICATION FOR SANITATION Pgrj.AT _ g ��/ /� ��--- -��'----------5�-- - -- Permit No. - -•-- (Complete in Triplicate) _______________________________________ This Permit Expires 1 Year From Date Issued Date Issued _ _ ,�l 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 -----_7.. ---- � '� -� SUS TRACT ••--------------------- Owner's Name ,�%�1 "'i r�— fJ -.. --------Phone Address .. �--_`'----�- /C Cit e Contractor's Name ._..__ � --____ _ iw.� � -----------------.License # - - /_rJ'f__ Phone , --- Installation will serve: Residence (Apartment House❑ Commercial :❑Trailer Court 0 —N . Motel ❑Other -------------------------------------------- Number ----------------------------•-- --. . . _Number of living units:---/.-_. Number of bedrooms -_.�.._.Garbd e Grinder!Y0--.. Lot Size _ ?� X_ _d---------- e- .� Water Supply: Public System and name --- c. __-_.--_`.___. ________________________________________________Private,( ' Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe 6C Fill Material ------------ If yes, type ____________________________ s (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 publicsewer is available within 200 feet,)PACKAGE PACKAGE TREATMENT SEPTIC TANK" Size__�__l�____. 1:�--------------- Liquid Depth _.S__.__-_ _ Capacity�J_01-Q6f-Type _ Material---l� No. Compartments -,�---------- Distance to nearest: Well ----- ---------------Foundation _1a------ Prop. Line -__- -----:_--_____ LEACHING LINE At No. of Lines ___.a---------------- Length of each line----- __________ Total Length 'D' Box ---/----- Type Filter Material hneI4-------Depth Filter Material __ .................................. Distance to nearest: Well .__ _P___.-__ Foundation ----1_0__ --------- Property Line ----ti—_11 SEEPAGE PIT ' Depth ___ --__ Diameter 1 0 _ --,?_-,?!'-"Number _.___�_________________ Rock Filled Yes No .� Water Table Depth --------19 ------------------------------Rock Size --�----------_r_____________ i Distance to nearest: Well --- --................Foundation _-_-� --_.____ Prop. Line .._ ________.__ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic ---___-__-__-----_---.-_---_-____Se tic Tank (Specify Requirements) t Disposal Field (Specify Requirements) ----------------------------------------••------------------------------------------------------------------••----------------------- ------------------------------------------------------------------------------------------------------ -----------------•----------------------------------------------------------------------•--------- -----------------• --------- --------- --------- ------------ ---------------------------------------------------------------------------- ----------- -------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 subject to Workman's Compensation laws of California." Signed --------------/-�------- --------- ---•-------------- Owner BY •--- L� Title ------ ------------ r �{ (if other than owner) FOR D PARTMENT USE 2NLY APPLICATION ACCEPTED BY7 ------- --------------- DATE --- - -_ ---.�..... BUILDING PERMIT ISSUED - ---------------------•------------•--------- DATE ADDITIONAL COMMENTS --------------------------- ------------------------------------------------------------------------------------------------------------------------------- ---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------ -------- -- ---------------------------------- -- ---------------------- --------------------------•• -- - - ---------------------------------------- - -------------------------------------- -- ---- ---- - -- -- ------ Final Inspection by: --------------- !-- --------------Date --- ---'� 1•� 4------- SAN JOAQUI LOCAL HEALTH DISTRICT C u 0 7 '/,4 D.... rAA