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FOR OFFICE USE: PLICATION FOR SANITATION PERT (Complete in Triplicate) Permit No. This Permit Expires it Year From Date issued Date Issued Application �s hereby made to p r pp y the San Joaquin Local Health District for a permit to construct � e�w herein described. This application is made in compliance with County Ordinance No. 549 and existing ules and Regulations: 1 �~ / ... f .JOB ADDRESS/LOCATION ....�........... .i. ....................._.._....... .......CENSUS TRACT "I...... .. Phne .................................... Owner's Nome -........6� Address �SCAGo!\ ......._ '........ ........... ...._..__._• . ............ City y ..___...... .................................. ........................ Contractor's Name __._.license # ........ Phone Installation will serve: J Residence.❑Apartment Housed Commercial ❑Trailer Gewrt• Motel 171 Other Number of living units:_..........Number of"bedrooms ___Garbage Grinder -9... Lot Size ..:... Water SuPPIY Public System and name :...:......... . ....-----...... ........_...•-•-•-...................__....--•...............Private .. Character of soil to a depth of 3 feet; 5ancf[] 5 Clay []'r'Peat C] Sandy Loom {] Clay Loom . Hardpan Adobe E 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:} NEW INSTALLATION: (No septic tank or seep pit permitted if uhllc sewer is available within 200 feet,j PACKAGE TREATMENT [ } SEPTIC TANK'[ Size_.::: ._:_ l X___.__•................ Liquid Depth ,:._ ... ..........- --•- Capac€ty ./q<)T. Type Phan --- ��^�Material- 'A/l/!C . �• No. Cor�npartments ........... F :stance to nearest: Well _____ .- ^ ..Foundation .:./�. ..Prop. Line ..�_.'�': __ LEACHING LINE No. of�Llnes _.__. ._,_.- length. of ,each line.__ Total Length :;D' Box 10�7_5 Type Filter Material Ay-.- Depth Filter Material ___ - --..... ........ .. .. - _ Distance_to_n agest:_Well-__ _" . oundatiof A.— '-Property-Line! !...._.... _ ...... - i SEEPAGE PIT Depth ' f Diameter iVume I RocC tiled Yes -- No :f / 7i r Water Table Depth `i f_ z ... �. e,to nearest:.Well _______ ......................... _ Fodon f _ p.ProLine Distant d 9 - - REPAIR/ADDITION(Prev:'Sanitotion,Permit ............................................ Date Septic Tank JSpecify Requirements] Disposal Field (Specify Requirements! .... ......:: ....�� ? ...!` ---• Af -X. ...... =- - -••-••...................•----•-•--••----•-•._-.......-••-•--__...................---•.... ii .............. ------------ _.....---.•-.----•--•-._......._.....--_.__...........---................._...:.....-_-•--.-_..__.__...._.....-..._......--••--.._ -------•--- --------- (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 aecordaace;.with San- Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Locol Health District.Aome owh r or Ilcen- sed agents signature certifies the following: a. "I certify in the perform to of h work for which this permit is issued, I shap,not employ any person in such manner as to be a subject to War an's mpensation laws California:" k ._.. Owner Signed .. _ .�'.` . - - -------------- -=---.--- - --....,.r_...:..:---•-••--- BY ._.__._ ._.. .............. ........__.i..s_ - . Title ...._..._.. r. .... ............ (if other than owner) ;6 FOR DEPARTMENT USE ONLY -- DATE ACCEPTED BY .��--- -'--(- •- --�__-•- ----=I...... ........•---..... 'BUILDING PERMIT ISSUED _,._ -•DATE .................6......................... ADDITIONAL COMMENT'S � .................................... . ._. ... r;f f-, ..................... .' -_................................--.... ............... ........ .... -....__-........•-................. _..._ Final Inspectio : ..__: ................ . .:.......Date .... .......... -------•--- ...................... SAN JOAQUIN LOCAL HEALTH DISTRICT 1 e u 13 24,. •jo oma._ CAA 7/7,) 'A u