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FOR OFFICE USE: APPLICATION_ FOR. SANITATION PERMIT -- Permit No. (Complete in Triplicate) , r - ------- --------------------------------------------- Date Issued _--91-7176 This Permit Expires 1 Year From Date issued ��, Application is hereby made to the San Joaquin Local Health District fora ermit to con truct and install the work herein described. This application is made-in compliance with County Ordinance No. 549 and !xisting Rules and Regulations: JOB ADDRESS/LOCATION/411� � - CENSUS TRACT /_�; Owner's Name ---- , L�-�1 ---------- f------ --Phone ------------- ----------------------- i 5 ,------------------ -------•--• CitvT'�+� Tzti------------------------------------ Address p�-�-�-�-----=-r_-� �/� - - �Confiractor' Name ------------------------------- License #/ � ,�f Phone __�' Installation will serve: ResidencegApartment House❑ Commercial ;❑Trailer Court ii Motel ❑Other -------------------------------------------- Number of living units:----,------- Number of Ebedrooms __._-Garbage Grinder _ p_ Lot Size _e:00- -e-�K-42 -------- Water Supply: Public System and name ----------------------- ------------------------------------ ------------------------------- ........Private ' Character of soil to a depth of 3 feet Sand❑ Silt❑ Clay .❑ ;.Peat❑ Sandy Loam.❑ Clay Loam,❑ Hardpan,4. �.`Adobe_j2r Fill Material ------------ if yes, type ---------------------------- E (PI-ot plan, showing size of lot, location of,system in relation to wells, buildings, etc. must be placed on.rreverse side.) NEW INSTALLATION: fNo septic tank or seepage pit-,permitted-if-public sewer is available within 200 feet,) t PACKAGE TREATMENT [ SEPTIC TANKSize___ �---�'�---------------` Liquid Depth ----�.1-/----------.----• � Ca acit O�? Type . -Z;70 rial_�-mo o. Compartments . ...........:.... Distance to nearest: Well __ ------------------------Foundation ._lU_ __________ Prop. Line _� �_____..-_-_-- LEACHING LINE} `. No. of Lines ________ __ Length of each line._-CSQ--------------- Total Length C .---------- V�. I D' Box 1- `�- Type Filter,Material �.4! . Depth Filter ;Material ,_Z - ______-,•---------------------•- Distance to nearest: Well _ -_________ Foundation Property Line i� SEEPAGE PIT Depth ._P?X l----- Diameter JJ------- Number ----_1<-----------f__ Rock Filled Yes j!� No 0 Water Table Depth ---- dO-------------------------------Rock Size ------------ Distance to nearest: Well ------------------------Foundation ________ Prop. Line --- ./___-_-.--- - REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______._-----------------------) i Septic Tank (Specify Requirements) ----- ---------- -------------------.--•----------- ,,.--------------------------- Disposal Field (Specify Requirements) ------------------1- i - -------------------------------------- ------------------------------=------------------------ ---------------------------------------------------------=---------------------- ---------------- .. __ --- - --- ------ ----- ----- {Draw 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 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 ' - --------------- j BY Title --------------- - ----------- ---------------------------------- - ( other an owner) a FOR DEPARTMENT USE ONLY '. APPLICATION ACCEPTED BY - --------------- -- - -- - - - --------------.----------- ------------_---------------------. DATE _�."__