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FOR OFFICE USE: *LICATION FOR SANITATION PERP _........_._..... . • ---..... y (Complete in Triplicate) Permit No. ......I .......... _................... ..... This Permit Expires 1 Year 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/L�AT �.- NSUS TRACT .......................... Owner's Nam ---------------------------- P� ... Address may, ' •............................... _.....,��'C! :. ._ �.1.-�•---.,�C4��'... �� .... city ��.. Contractor's Name .... •- .: �.� . . ... tG.... �' = .._.License #'° ,�rl.`7... Phone Installation will serve: Residence ❑Apartment House Commerci Number of living units:O7-� Number of bed oms�. Garbage Grin er ��_�_... Lot Size .. �_ . Water Supply: Public System and name ........ .: .... --Ls1. -_ ... ...._..........................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 0V 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 seepage pit p rmitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( J SEPTIC TANK f ] y¢ ize Liquid Depth Capacity .................... Type .................... Material...................... No. Compartments ......._.............. . Distance to nearest: Well ....................................Foundation ...................... Prop. Line ................._.... LEACHING LINE �' No. of Lines ........,---__---.-. Length of each line.... U..`.............. Total Length ....ZAq................. 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well /.�1 --------------- Foundation .��........_..... Property Line ...,�.................. SEEPAGE PIT �Sj'� Depth p7� ........ Diameter ei:5 .'..... Number .......�................ Rock Filled Yes � No O el Water Table Depth /�/. .rz .. ' ---- •.... ...............••--•--......__....Rock Size ---- ...................... Distance to nearest: Well .401 .......................Foundation ..Zd............ Prop. Line ..'s............... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ------------------------- - ---•--•--------••-•-----------•---------•----------------------•---e -- Disposal Field (Specif Requirements) .. �. .�� '.......`.... T yJ1•-----------------•----------.-.-------------------------------------------------•------------ - ------- -- --- - ----------I...........-- ...................................... •••-•-•••--•-•-•••---•----••••-•---•-- --••••••----•••-••••••--••---••••---------•-•---•-•-•-•--•••....--•--........ (Draw existing and required addition on reverse side) I 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: "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 .. !u —:.. -•---� — •----.. Title ....- .. � cCt->«:. �1 (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------•-• --• -.... .. ....... ...............••---......... DATE --•• ... .... BUILDING PERMIT ISSUED ..................................... ................................................DATE ........................................... ADDITIONALCOMMENTS ..........................................................•-•--------••----•--........----------••-•--••--••-------••---....----.............-•••--........... --••-•-•--....•-•-••••--•---•----•-----•----•-----••--•.......................•-•..............._..-••-••--••--•••••-•........••-•---••-•-..........•--•--•-••--•--•-•---•--•••••••••• .................. .......................... .......... .... ............-•-•---------------•-•--•---•----------.....-------•------•------•--•-••-----•-----------------------••--•••-•---•--••••.--_.. ------------------- ----------•--. Final Ins ection b .._ . P y: ... •_-... Date ... _...�.. ..-Gl.' . ....�... SAN JOAQUIN LOCAL HEALTH DISTRICT