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FOR OFFICE USE: < ' y _- APPLICATION FOI`IANITATION PERMIT ------ -------------- ----•------ ----------------------- 7/ .5`�'s .. .�. (Complete in Triplicate) Permit No: _-+ _____ .y - This Permit Expires]Fear From Date Issued Date Issued --- 7/ 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 ade in compliance with County Ordinance No. 549 and t�g Rul s an Regulations: k /D� fp� JOB ADDRESS/LOCATION ._ �5L_W1KQ,(.f�i.+_ .--(>� . ,�' --j _CENSUS TRACT ------------------------•- Owner's Name `-----�---- Phone Address ------------ ----- �� City Contractor's - -- - - - ---- _ --- - --- - ------- ------- Contractor's Name ---------- --- ---- _r----------- -----.License # /CV- /f-------- --- - Phone - -- ------ - Installation will serve: Residence []Apartment House CommercialT railer Court Motel ❑Other ------------/Van-4 Number ❑ Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size Water Supply. Public Sy.'stem anname ------------------------------------ ------- - - - d - - - -i------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam;❑ Hardpan ❑ Adobe NO 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: r �.. " k �(No septic tank or seepage pit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT +1Ze �j}_ ( rr Ca acit f Yp ' -� =� .�'=-=---------- Liquid Depth _m-71 -- [ � SEPTIC TANK ` p Y _ •----- Material4-_tom No. Compartments --- -r---------_-_ i ---- T e :Distance to nearest: Well ' ----------------------------------Foundation ------- Prop. Line ---- LEACHING LINE �y No, of Lines ___.-. Length of each line--- -- _ F� ------- - - g . .. '�� Total Length6 D' Box - Type•�._ Fj Filter Material ---__ - ------Depth Filter Material _ ------------------------------ Distance _Distance to nearest: Well ------------------------ Foundation _ ____ property Line I SEEPAGE PIT De th 74S- _ Depth Diameter -- -____-- Number __rl:� ----------------- pock Filled Yes No ❑ Water Table Depth -------------------- 1 1 r� ---------------------------Rock•Size �6 Distance to nearest: Well ----------------------------------------FoundationO ----- Prop. Line,`-s! `-------- REPAIR/ADDITION(Prev. Sanitation`Permit# _------ ---_ ------------------ Date ---------------- Septic Tank (Specify Requirements) -------- ---------------------------------------------- ----------------- - -I-- F --------------- Disposal Field (Specify Requirements) ------------ ----- ----------------------------------------- ------------------------ --------------------------------- --------------------- -------------------------------------- :JDraw 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 Reg ulations.-o-f-.therSon_Joaquin Local-.Heal ome.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 sholl not employ any person in such manner as to become subject to Workman's Compensation laws of California.!, Signed --- ------------------ ; '.x:e' .,..---•"^-wokr..:.,.�.{"Irl.---'�-=�,-�.:-...--- .i:.,-.� Owner BY __-.._ .- Title (If of r than owner) ------------ ------ ---------------- A1tTMENT USE ONLY APPLICATION ACCEPTED BY -----__- BUILDING PERMIT ISSUED - DATE -: s - ---------------- ADDITIONAL CO EFTS --m _ - ------ ------------------------- ---------------------------------DATE ------- ----------------------------------- -- - -------------- --------- ------ ---------------------------------------------- - Final Inspection by; -__-. -- ------------- - ----- - - - -- - -----------.Date ----- ---- SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'S8 R . 5M