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FOR OFFICE USE: _ APPLICATION, FOR SANITATION PERMIT ..:..........:.�.:..:... '. .. ... [Complete in Triplicate) _.. ._ . ._ .._... ... .Permit No. - 5. d f.� Date Issue ._ ........---•........................................... This Permit Expires t 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 compliancewithCounty Ordinance No. 549 and existing Rules and Regulations: 3 S[ I T lei 148 Al3DRf55/LC#CATs N ........................................................i CENSUS TRACT ...�._.__. ..�.,....��t�.�' '�t • ..................... Owner's Name 6- Oft,--•--•-•-•---------- - .• ................. one ... -f---- i Address . .......... City.... fid[? 7�02 - ---- Contractor's Name ...... "...Gv e./ v r (n` f s.`� a P'rr -..--License #-..:::..4............ Phone � Installation will. serve: Residence Aparftent House{] Commercial Trailer Coeirt 0 i a Motel ❑ er •..................•-...... Number of living units:...... .... Number of bedrooms -._—Garbage Grinder ..---....... Lot Size •. Water Supply:.Public System and name................. - -- ........................Private [] Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay [J Peat[ Sandy Loam Clay Loam,) Hardpan ] Adobe❑ Fill Materia! . . .'I#Ye s,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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANKS - --• Liquid Depth .-----I ... _ Capacity 's-$D..-•-• TY .. Material.... .:... No. Compartments _ ; ...............1y LEACH Distance to nearest: Well .. b, 1 -----.........................Foundation.../_.�---........... Prop. Line ..s�---......-- ING LINE [ ] No. of Lines ..�-------.--_ Length of each line..•,AJC ............... Total Length .12A.............. 'D' Sox .�j1 ,_ Type Filter Material -0.:&: ._10. ! .._._..Depth Filter Material .._.1.�.�--•--•-----�------ i - Distance to nearest: Well ...479............... Foundation -_-�.b...-_.......... Property Line ` - " - in SEEPAGE PIT ( ) Depth __o .s_�_......_. Diameter Z..`: Number ...:............. Rock Filled Yeses No --- --_ Water Table Depth ----./670.........-. :... ... -- -.Rods Size ..�:�i..t.:.... Distance to nearest: Well ---- '-------...:.............Foundation -S Prop. Line r REPAIR ADDITION(Prev. Sanitation Permit# _ Dote Septic Tank ISpecify Requirements) ........................................... .................................»....r»..._._.... ......................................... .• V .......................................................... Disposal Field (Specify Requirements) .__.....•_-................................................, .........•--•- •---------------------- •------------• . .....---... .......................................... •---------••-••...•.. ------•----- ............................ . ..............-------------•:-----------------------------------------------••----•'-•----.....___.----•----_............................; ••-• (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 i e performance of the work r which this permit is issued, I shall not employ any person, In such manner as to becom ubl�Workman's Ca sation laws of California." Signed --- ------- ---------.------------------- -••--- Owner SY ----- -------- -------------------•---•---------•---•- ----.-. ----------- •----- Title ............... --•- (if other tha er FOR DEPARTMENT :USE ONLY APPLICATION ACCEPTED BY------ . ._.. :._:._...DATE, .Q_--.._�. .;�. .............. ..-- ............. . . BUILDING PERMIT ISStlED --------------•---._----.._-_. _ ------• --_-_DATE _-..._........ ._ . ADDITIONAL COMMENTS ----•---------------------------- ....._.-..,......_....__. ..---•............... -------------------- Final inspection by: ... _ .......... ngtef. .-.�-�._._..... .... .. .. EH J 3 2h -613 lieu. SAN JOAQUIN t,OCAL'HEALTH DISTRICT 8/7h 3M �