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- FOR OFFICE USE: �" ..-._, _ _ r APPLICATION >=0�i"�SANI AT[G PERMIT Permit No I = ---------------------------------- -- --------------- ---- ------------------------ -------------- .. Date Issue -------------------------------- -------------- -. This Permit Expires 3.Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and i Stall the work herein described. This application is made in compliance with County Ordinance No. 549 anal existing Rule's and Re ulations. I S r ��F �t�,��u � :�-------; ------- --'---CENSUS ,TRACT JOB ADDRESS/LOCA ON-------------------------- i �LL �j i ---- ----Phone# + Q - Owner's Name 4 r- pJ "' - Address - .i t �-------A SIC t --------•-•---------•--- City ----- -��' . -------------- --- --------- �+ Contractor's Name -_ - l.. !*�T" -----.License # ------------------------- Phone - --- Installation will serve: Residence 541partment House❑ Commercial ❑Trailer Court ;❑ ` # Motel El Other - _- -- 1s " Number of living units:_-- __- Number of bedrooms _: _ _ _ +► :_ Lot Size --. _ _ -- -__Garbage�Grder -.-- I � -- Private Water Supply: Public System and�name ;, ,; �Y y Y p ? Hard an❑ Adobe'. Fill Material ------__-_-- If Yes, type ------- '_----------- Character of soil to a"'de th of 3 feet: Sand' Silt,❑ Cla ❑ Peat Sand Loam Cla Loam.; a p ❑ 4 (Plot plan, showing 7 ize of lot, location of system n relation to wells, buildings, etc, must be placed on verse side.) t s g ,&*A 4#44 ^1d r NEW INSTALLATION: (No se tic tank or seepage it permitted if public,sewer is available within 200 feet,] P., p R p Pt , e /if PACKAGE TREATMENT f ] SEPTIC TANK'[ ] e Size- rli'_ Liquid Depth _ ""-._ ��----r; �, '' ;. �� 1 Capacity W-6 _ Type �"� Mafefia! o. Compartments .� --- 1 Distance to n�dr�es Well _-__-- at Pro • Lin t P r11C+"G p ,r Fouri ion LEACHING LINE f ]. No. of Lines ------ -- -Length of each lin------------ -. -------- Total Length --- . 'f --- 'D' Box es"" Type Material epth1Filte hll eria1 fI ..................... T e Filter Material �'�' 1�.D v1K -_ t u� ......... Property" Line ++ - ------ Distance ' j 7 De th • ta nearest. Well r��- -Fon n f• C ] p Diameter,:--_ Number ----___ __-- Rock, Filled Yes No .❑ "te l _*177[N .. - --- --i t- Water TableDepth�----------------------------Rock Size -------- ----- -------- - - Ji Distanceearest: Well -.- � -------- •.Foundati __ _ --- Prop. Line _____ + . ------ IL . .00, REPAIR/ADDITION(Prev. Sanitation Permit#.-------- ---- --------- Date ---.------------------------------ ) i Septic Tank (Specify Requirements) - ----- ' ------ _-r - ------------------------------------- _1 ----- --------------- ji l t', / - . ------------------------- Disposal Field(Specify Requirements) -_- ------------,.------- _- ---- ----- ---- r ---- 4 0 -- 5 ----- - '` r ---- ---------- - --------- ------ --L----- ------ �-------- --y -.----- -�___- ----_ ------_ (Draw existing and required addition onsreverse side)' Ther cerci thatf, have prepared this application and that the work will be done in :accordance with San Joaquin Y certify �" County Ordinances, State Laws, and Rules and Regulations-bf!the3San Joaquin LocaljHealth District. Home owner or Rcen- sed agents signature certifies the following:", ', '. "I certify that in the performance of the work for wxhich this permit is.issued, 1 shall not employ anyl,person in such manner k as to beta subje t'io Wor a`n's C91 pensatian laws of California." i / f Signed - ' - --- ---- Owner F i - -----t---------- _ ----- --------- - ------ ' ------ Title --------------- ( r than owner) FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY --_i-1141-~.... ...... --- - ----------- -------- DATE S j �'• - ----------------- -------------------------------- - BUILDING PERMIT ISSUED :. t ------------------------------- ------------ DATE --- ADDITIONAL COMMENTS s + �'-------------- --------------------------------- - - ------ -------- - -- - -- - - -- ------ - --------- ,: -------- I -- -- -- - - -- --- -- --- -- ------------ --- - Final Inspection b t = V - -------------------- Date _- _6 P yt .S6N.JOAQUINLOCAL-HEALTHy?I-Sj.R_1CT E. H. 9 1-'6B Rev. 5M �"