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FOR OFFICE USE: , LICATION FOR SANITATION PERS v _... - .. ..7 . (Complete in Triplicate) Permit No. Date Issued ld��".7y ........ ___.__...__.--._,__-.------__._.._..... This Permit Expires 1 Year From Date Issued .. . 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 jcompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....... ."La . . TRACT Owner's Name ............. . ....................... ---------- ...r---- -------- Phone ..._..... .......................... Address , - ;er CityQ Contractor's Name ....� ,�G` - License # —2 P; W. Phone , Installation will serve: Residence ❑ Apartment House,❑ C mmercial Trailer Court 0 MotelOther . .. . . . Number of living units:. lumber of b rooms ..... .....G age Grinder ' -Cot Size ..l.. ..... ............ ---------- Water Supply: Public System and name --C .e . .............. Private,j '' Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .----------- If yes,type -----_------_----- (Plot ---- ._....__-----(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 perrr;itted if public sewer is available within 200 feet,) ��++ r- PACKAGE TREATMENT j ] SEPTIC TANK j K�� `� tae�' �. � �. .. �_.._ Liquid Depth ...b............. Capacity -- ------- ------- Type .................... Material------- - ............ No. Compartments ..................... Distance to nearest: Well --- .....................Foundation ...................... Prop. Line ...................... LEACHING LINE [ No. of Lines _/..... ............ Length of each line---W- ------------- Total Length , �........._.._...._. / �� .0,r 'D' Box ..�.....- Type Filter Material ._,ojo" •..._Depth Filter Material ...o,r� ......................... loo �y stance to nearest: Welli/dv.............. Foundation _L_a............... Property Line 15-_-_---_-.._----. G• K ` ` Rock Filled Yes No SEEPAGE PIT �'S Depth oe - _... __ Diameter _ __...._. Number ❑ Water Table Depth -------- __._.. ..................... Rock Size ___C7..�/ Distance to nearest: Well ... ......................Foundation _.__.AQ__..._. Prop. Line-6 ............ REPAIR/ADDITION(Prev. Sanitation Permit# .......... .... ...... ................. Date ..................................I Septic Tank (Specify Requirements) TT -- --------- -----•---c --.-.-....c.:.:.: ---- Disposal Field-- - --------- ---------- (Specify Requ' ments) ------_-____. �'-�22_-.1_e _-.-- ----_------ . .. . .-•---- -- . ----- I . .-.-Z � -------- ------- - - ------ ----- - ( w existing and required ion on reverse e 1 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 licen- 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 as to become subject to Workman's Compensation laws of California." Signed .... ..... ...... -------------- ---------- ------ ------------- ---------- ------ Owner By -. --------------- ------- ........... Title ------ ....... .......... ....... (if other than owner) FRA DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-- -� •------ ------- ------•--------•--.. ............ DATE BUILDING PERMIT ISSUED -- --------- ......................................... - ..............•--.............................----DATE ................................... or_ ....._.. ADDITIONAL COMMENTS ... .._. oc....... ..._ .1' .. -•- .et-... ................................................................................. i/--•--•-•---- ------------- --- ••-•-••----•-•--•-•--•-....�------------. ....................... ........................................................ ----------- ........... ................................. -•----•-----•-•--------..--------•-----_----•---•--•-----------.---------------•-------.rQ-..---•` -----------•-••------ Final Inspection by. .. _........... � ........................ ...------....----- ._..........._....Date .., l� SAN JOAQUIN LOCAL HEALTH DISTRICT