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FOR OFFICE USE: \.l APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ___. This Permit Expires 1 Year From Date Issued Date Issued ZV-1461 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/LOC/ IONp R3.1 -�. /.4 -_ -� .- 9A..._.4Aa-7-,.-r..e)_CENSUS TRACT ....................... Owner's Name . .v Lt[ o`i c t. ... _ ----- Phon . ... ,j Address rl, _. ...... ... City .f/L�. .. -.. Contractor's Name - _ _..----. - .,.. . ...License # h7397�. Phone .............................. 6. Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court C1 Motel ❑Other .-.. .... ........... ............. � / Number of living units: t_ Number of bedrooms �._..--Garbage Grinder . - Lot Size .--.. .� at <n� ........... Water Supply: Public System and name ._..._................_......-...._ .......................Private (g— 0 Character of soil to a depth of 3 feet: Sand L] Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ )�! LHardpan ❑ Adobe ❑ Fill Material - .. If yes, type ... ... ... Y (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 Sizecrt��i1�/4.� .J.'-a2.. --.. -. Liquid Depth _ ..,!--------- Capacity rboo U Type -(14�y Material .:.. No. Compartments -2.......�._...__� aaU - � / Distance to nearest: Well _.-...Foundation .. .1..0.........__ Prop. Line ...5............ LEACHING LINE [/f No. of Lines 3 _ - Length of each line __-�4 Total Length � r✓1.....- 'D' Box Type Filter Material ----s.K-----Depth Filter Material ---------. -...--.._.--- Distance to nearest: Well ... .14V..1.._. Foundation /Q_*... Property Line -Jam../. ............ LSEEPAGE PIT [+] Depth r Diameter ------- Number _ J _ �.... Rock Filled Yes No C Water Table Depth -------- .�-...__._.---.--.-----.-...Rock Size ../L?-.-,X------------ Distance to nearest: Well .. _ ..�.S�.-r--...__ .....Foundation ..--_1('7.�..... Prop. Line ._.�.......... LREPAIR/ADDITION(Prev. Sanitation Permit# -------- _ .......... ____ Date ............................... Septic Tank (Specify Requirements) _ -.-... --- ---- -- ------ -- LDisposal Field (Specify Requirements) ._.. .............. ............... __ _ .......... .. ....... . _._.. .. .. .- _ _.. ......... _ - . _.....- --- - _ -. ... -_ _ - _ - - .. .. __ .. _._-.._. .. (Drdw existing and required addition on reverse side) 1 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: L "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 tork an's Compensation laws of California." Signed - . .. ..... ..---- .. ., .. /. .. .. ... .. .............._. Owner r- ` BY lX i v - l'f _. Title _.._.. _. (If other t an owner) FOR DEPARTMENT USE ONLY -- APPLICATION ACCEPTED BY DATE r BUILDING PERMIT ISSUED _ DATE ? L ADDITIONAL COMMENTS /Ltdj �o c��rEYat ...... . __ .. LFinal Inspection by: . . ....... _ Date -... 3.///7yyy[�...-- . SAN JOAQUIN LOCAL HEALTH DISTRICT