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FOR OFFICE USE: ii 'PLICATION FOR SANITATION PIER: 4- iA _ {Complete in Triplicate} Permit No. .........~ ------- -------------- This Permit . -Expires 1 Year From Dote Issued Date Issued .. 71" .--- ---------------- Application islIhereby 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: I JOB ADDRESS/LOCATION .-.-..-- .-. -- ...- -- . �---------.............��--.4�,l[..CENSU . . . .p. -. •---- Owner's Name G ----�-'L--�� Phon Address - �el eV.11 /� ------------------------- City ��L !- .............................. M .57061 (�To� �-L/.C' Contractors Name ----- -- ".".License # .. - --- ----- .-- Phone Installation will serve: Residence MApartment House❑ Commercial []Trailer Court ❑ r r Motel ❑ Other Number of fixing uriits:.....!-.... Number of bedrooms --- --- Grinder . G?._.. Lot Size f.�.... _ --- Water Supply!' Public System and name --- ---- •----- ----------------------- ------•------------------------- ------Private 2r, Character of soil to a depth of 3 feet: Sand'[] . Silt❑ Clay ❑ Peat❑ Sandy Loom -❑ Clay Loam ❑ I� !h Hardpan ❑ Adobe;X Fill Material ...... If yes,type -------------..-__-.._ (Plot pian, showing. size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)' \ NEW INSTALLATION. iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT ] [ ] -------- ------ Liquid Depth -------------------- Capacity ---------.. � SEPTIC TANK� Size-------------------•------"----"- ------- \,. I - Vl Capacity -------------------- Type -------------------- Material-..--- --------------- No. Compartments ...................... Q IDistance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---"---•-'---- [ ] Length of each line---------------------------- Total Length :..-""......"......:........ LEACHING LINE Ao, of LinesD' Box ............. Type Filter Material ..------------------Depth Filter Material ----------------------------- Distance to nearest: Well ...................._-_ Foundation --------------------- Property Line ........................ SEEPAGE PIT [ ;}epth --------:........... Diameter ---------------- Number ---- Rock Filled Yes ❑ No i❑ f� j Water Table Depth ------------------------------------------ .......Rock Size ---------- ................ f1` Distance to nearest: Well ----------------------------------------f=oundation -------------------- Prop. Line ---------------------• REPAIR/ADDITIION[Prev. Sanitation Permit# --..---•"--------------------"-------------- (Specify s � Date ----..._..---.-- -.---------------- Septic TanO(Specify Requirements) -"-- -- ------ . ------------------ ------------------------------------------------ - ) - ---. .-i ---- Disposal Fiidl (S ecif Re uirements) --------- .---- A. --- 1f- --------,---- .-- •"�---.�-.. . �:. ..................!R---........... ...... (Draw 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 Iicen- 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 eject to Workman' mpensation laws of California." 5i ned g ------------- Owner as to become BY .. Title ...... . ---- (If other than owner) FOR.DEPARTM NT USE ONLY;— APPLICATION) NLYAPPLICATION)ACCEPTED BY .. ..... .. ..: . --.- DATE -------------------------------- BUILDING PERMIT ISSUED -- ------ ---- - -------------------------------------------------------- DATE COMMENTS . =.`-... ,1 -- -------- ------ ADDITIONAL i h y ayrr,..-. .:. -�^: T =-----.---.-•--------------- -•--.---..................-"------.-- - .-----...-- ------------ ------------------------- ------------- --- ---- ..------------- "- ------- - -- ----------- ------- ,- ------------- - ----- --------------- -------- ---- ------ Final Ins ection 6 ! f — ( f A Y• ---� ------------------------------ - -...------"---- ----....DateDate _ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1- Gia Rev. 5M