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FOR OFFICE USE: APPLICATION FOR SANITATION 41MIT - - ----- ----•----- -------------•--------------------- .., Permit No: . ,�. (Complete in Triplicate) - :........ .........•-•--•-------••---•......---- Date Issued This Permit Expires 1 Year From Date Issued y 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: 7OU._....._ a !2 -----C----L�.v /4410ENSUS TRACT ------------------- ------ JOB ADDRESS/LOCATION -------- ... - 1 J -1 ��G1 Owner's Name—,--:- ---- -- - ✓/1C.4;E--:--- _f. _�_ c/--- ---•--------- -------------------Phone --------------------••-------------- _� ------------ City Address `-.......----�.lZO�i-- --------C•�_ --�-�-- --�-L�r----------------------------•-------....---•-- ,S, M� 7y ! /'i11 License # -- Gi�"---_._ Phone i Contractor's Name ---'-.... .4- ..... J- s -- t Installation will serve: Residence NApartment House Commercial IL-]Trailer Court Q i Motel ❑Other --------- ------------ ------ ------- r/ Number of living units:.....f_... Number of bedrooms _JI--- Grinder ./�!�?-___ Lot Size __._�. .. C.'. 's------••---•• 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 ❑ Adobe jX 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT,j I SEPTIC TANK.1 ] Size------------------------------------------.."_'.Liquid Depth _______.____- ? 1 Capacity i Type .................... Material-----------.---------- No: Compartments --------- ------- Distance to nearest: Well ------------------------------------Foundation ____---. __--- Prop. line ____......_..:-.-_-_-- - Len .... LEACHING LINE`� [ ] t�. of Lines---------- ----------- Length of each line____..._______..------�:'- Total Length ;.......__.............. _Deth Filter,/Material --.-_ 'D' Box ... -"�__.. Type Filter Material ----- ------------ P ------------•---...------••----....---- r/" I Distance to nearest: Well .•---------------------- Foundation _:_...----------.- Property Line. .................... SEEPAGE PIT [ J ;9epth ____t..�'-- Diameter ___--__-_-.--.- Number 1_^__..' ...-------------- Rock Filled Yes Q No.i0 1I��vWater Tabl4bepth - ----------_- ---- ------------------_ROck Size -------------_.--------- ------ 1y � �Foundation -Pro Line ---------------------- Distance �x to nearest: Well -----------------------------------, .._ _...---•-------•-- - v P•f REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------- - -------- Date .____._._...--.-------••------•--•) ' . . - -- Septic Tank (Specify Requirements) .---:-•--_-- ----------------------------------------------------------- ...�...._-. `;. -•-- Disposal Field (Specify " GiF& encs) .._..___.f,� --- prX--••••.... `��•.�••-- ---/- /�4--- -- f f ------• --------- ----•--- ---- -- --- - • - -- •----•---- --- ; >,.�.. I .r =-------------------- --- I (Draw existing and required add:1jion 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 becomS,#bject to Workman' mpensation laws of Ccilifbrnlb.." �,-G%�_----. Si ned .... Owner g - "Title --------------_-- --.---_ ......}................................. i8Y --------------------------------- _---------- -----------'--------••••----•-•-•----- . ;, (If other than owner) FOR DEPART NT USE ONLY 2!1 _._. .._ .. . .} ---------------- - APPLICATION ACCEPTED BY DATE BUILDING PERMIT ISSUED --- -- DATE -------- - ------------------------- ADDITIONAL COMMENTS ------------------ ---- - - ---------- ------------ ------ ----- --••---•--•----- - - --------------- s --------------------- --------------- ............ ' ------ ••---- . . --------- Final inspection by: Date ._....fie. ....... . ....... . SAN JOAQUIN LOCAL HEALTH DISTRICT (