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FOR OFFICE USE: APPLICATION FOR SANJTATION PERMIT v . ....................................................... Permit No. ...... (Comlet*in Triplicate) r� .............................................. P P Date ISSUed .� / r ••••------•P-•.-••.......••.......- ••,Y•,.••-- -••--, phis Permit Expires 1 Year From DPte Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and Install the work herein WPV44 , described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotionsc JOB ADDRESS/LOC Oar'-cr1.�6..�.......v.4 1��......... .............CENSUS TRACT .... ..... z i Phone .................... ....--- i , Owner's Name .... _. ��. ...--.Ci. ��..... ..... ....................... ...... Address .... .....©�0- 1 � ,../(.......... .. .... . .... 'Y x Contractor's Name ........... License # IX* f.. .-. Phone .......................... r' Installation will serve: ResidenceeApartment'House❑ Commercial ❑Trailer Court ❑ Motel ❑Other............................................ Number of living .. units:.....f.:... Number of bedrooms . ..Garbage Grinder ... - . ... Lot Size - 'i Water Supply: Public System and name ............................................. .............................................................-..Private;r pp 3 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ElPeat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ... .... ... If yes,type............................ 31 (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 I ] Size.................... Liquid Depth ......... • :. Capacity . ... .......... Type..................... Material-.......... No. Compartments ...... Distance to nearest: Well .. ... ...........................Foundation ........ ............ Prop. Line ...... ............ Length of each line ......... ........ ...... Total Length ............................ LEACHING LINE [ ] No. of Lines ................. 9 s -Depth Filter Material ............................................ { 'D' Box ........ Type Filter Material ...... .... ....... Distance to nearest: Well ...........- Foundation Property Line -..-.... ti SEEPAGE PIT [ ] Depth ..... . Diameter ................ Number ....-......-. Rock Filled Yes ❑ No Water Table Depth Rock Size ............. .................... Prop. Line ..... Distance to nearest: Well ... .'.:...:..............•........-.. Foundation ..-...... ...... Date . REPAIR/ADDITION(Prev. Sanitation Permit ..........-.• ............ ................................1 x ............- Septic Tank (Specify Requirements) ............ .. _... Disposal Field t�pecify Re ir-ments) i, —Ple� x d..4.- 1�� ..., mQ..................................... . ........................ ;: �• . • --•-••- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be don* in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horn* own*r er Ilcen- sed agents signature certifies the foll:)wing: "I certify that in the performance of :he work for which this permit is issued, I shall not employ any person in such mann*f as to become subject to Workman'—$-C"ensaHon laws of California." - Signed ... ............ . Owner 6 itle . ._ 6` i........................ (If other than ow6er) A,.J�d IR DEPARTMENT USE ONLY _ ---- i APPLICATION ACCEPTED BY . .._l'"' ....:." 'c�"'................................................ .DATE..........5...-..-......-...........---. BUILDINGPERMIT ISSUED ......................................................................................................... ADDITIONAL COMMENTS................... ................................... .........._.......................................... . .................................-........-............. .............................................. ..-........ ............. .......... .......... ............................ ..................................................................................................... ... St-..... ........................-...Date .. . is-c-�(.../ ti~✓. ............................ �............................ Final Inspection by: .... ...•••, SAN J AQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M • ,.. ..•, �: rt��,,� ,. o .t ...,e""i�aY� .F$,P.'�'.3�Srni"�,.R,$.iSl�ey?3ia7 �' ��[iu`11�.r ��: ��+e-fi�:.