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FOR OFFICE USEJ APPLICATION FOR SANITATION PERMIT �7 S 6� _ Permit No. l ------- - ----- ='' - --------------------- (Complete in Triplicate) ----------------------------------------------------------- Date Issued---------------- (° ---------------------------------------- This Permit Expires 1 Year From Date Issued San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby made to the described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: B 2S, t l r!o- 4P17D--(- OB ADDRESS/LOCATI N �' C ' S TRACT - -=--- - -------- - -----Phone ------------------------- ••-------- Owner's Name ------ --- C1 - --------- Address ----------------- ---- - _ - _ ` x/;"44 --° ............... License# [ �-� Phone�- ------------------- Contractor's Name _._ -- ------ - Installation will serve. Residence ErApartment House❑ Commercial ❑Trailer�Court IMotel ❑Other --------------------------------------------- Number of living units:_-_ _ � Lot Size --_- __-_.�f-_ �'- ---------------- _----_ Number of bedrooms t- _--____. arbor- a Grinder ._ _ __ -- Private 4 Water Supply: Public System and name -______---------------•- ---- -• •- --------------------- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam .E] Hardpan,❑-- Adobe'❑—Fill Materialyes,type --------------------------- IN, f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed ton reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within=200.feet,), PACKAGE TREATMENT [ ] SEPTIC TANK SizeA- ------------ ------ Liquid Depth..- -_ ____.---...-__---- t, �,,/ - �- Ca acit T e -1 ee/,j-�--- Material �� No. Compartments ___ _.-------------- Capacity. ------------ �. P Y YP q 1 ��. Distance, to. nearest: Well _-4-0------------ ------ ---Foundation _� ------------- Prop. Line ._ s�`-•------- ��. 1 [ Total Length ,�-�� LEACHING LINE , J No, of Lines ----- --",�� -- Length of each line---�--- ---f , ;V • {' - lam. , ,. Ai 'D' Box ! _ _ Type Fitter Material/ fP Depth Filter Matenaf� ---- -- --- (--------------- P � ln ••-_ Distan a to earest: Wel! ----------- Foundation �� ------- Rock FilledYes f na SEEPAGE PIT ] Depth -------------------- Diameter ---------------- Number ---__---- C - --------------Rock Size ----------- - Water Table Dept}i7-----------------------------�'; i WX '*` ------� ----------Foundation --------- Prop. Line _.. �Distance to nearest: Well ---_------_---_- / - r- ------ Date- f -------------------------- ON(Prevm ------- --REPAIR/ADDITI - � ) - .• -. . Septic Tank (Specfy Requirements),;`--- ---------------------------- —�- -z Disposal Field ( pecify Requiremen ) ts = --------- ---------- --•--- -------------------------------------------- ------------------------------------------------ -----•----- ---- - - - - ----------------------------------------- --------- ------------------ ------------ - - (Draw existing and required addition on reverse side) 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 Sa Joaquin Local Health District. Home owner or licen- f sed agents signature certifies the following: 1 k "I certify that in the performance of the work for.which this permit is,issued, 1 shall not employ any person in such manner i as to become subject 10 W,orkan's Compensai:jt;laws of Californita." Signed --------------- --------------------- -1 ,. .�,/ Owner Title ----------4101 —------------ ------------------------------ (lf r than owner) f F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --. _ ------- ------------------------- ----------. DATE .6_`�`1' ---- DATE ------- --------- BUILDING PERMIT ISSUED --------4-------------- ------------ - --- - 1 ------ _ - r- -- - ,• ��c-ti.ar ---�.,s�c�f�-ewe. - ADDITIONAL COME T • _' -�!_ -��__ Z '` -:--- --`-- % Q. .,�----------------------------------------------------------- ---------------------- --------- Final Inspection b -------- -- -------- ---------------- ---------- ---------------------------- ------------------------------------------------ t / r ! ---- ---- --�- ----- ------------- ---------------------- ---------- --------- --Dae --.. r------ --- - - -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M