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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FWe*SAWTATION PERMIT ................................. -- -------- Permit No.7,�.'40.,5,157_ i - (Complete in Triplicate) ------ V rr77 7 i e Date lssued.l.---r .}'---� i ...........................------.---- ----------- ...... This Permit Expires 1 Year From Date Issued i 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: Y 2 JOt5 ZESS/LO TION.n- %' ... _.� 0 . . .. CENSUS TRACT..................... j� ! Owner's Name ... P1. ..--rl �. �. ...........................Phone --- • ..........-• ......... .... Address-�._ . . ...4�_Q. ------fN. .a ES-- ......:. City 1-Q-C- O ...._Zip = Contractor's Name._.._.- 1 .�. License #. _ . Phone ... F Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.... . ------ ----------------- ---- I I Number of living units:--------------Number of bedrooms...5" Garbage Grinder...._._-....Lot Size.------ ..- - - - - ----- I Water Supply: Public System and name...------------ - - ...----------- ------- -- --.--Private El k Character of soil to a depth of 3 feet: ` Sand ❑ Silt ❑ Clay ❑, Peat ❑ Sandy Loam ❑ Clay Loam ❑ + Hardpan ❑ Adobe FIII Material.. .... ....if yes, type.......------------ (Plot - -(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,) i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-----------------------------------------...............---Liquid Depth....:._.- ..._--.. .. ---- ' Capacityr _ � -.T e--- •... ...... ......Material-------------------...,...No. Compartments ------• Distance to nearest: Well---------- .......... ..... ....Foundation.......... ....Prop. Line........_............. ° LEACHING LINE [ ] No. of Lines. ..............Length of each line -------.....------ :-__.- -- Total Length _. .....--...--.---- - ----- 'D' Box..._..._....Type Filter Material------..__...- ...Depth Filter Material...----...-_--------------------------- •.---------. Distance to nearest: Well--------------- -----_.Foundation----------------------------Property Line..-.-_--------................ SEEPAGE PIT [ ] Depth.;...... ; ,- -Diameter....................Number-.------------------------------ Rock Filled Yes E] No ❑ 4 Water Table. Depth................. ------ ...............Rock Size.-............ -- _ ----._.....__ ----------- -- Distance to"nearest: Well---------------____... .... -----Foundation......--- ......Prop. Line------- ---- -----r----.._. REPAIR/ADDITION (Prev. Sanitation Permit#-----------------------------....... .... .. .......Date-...............---.-........... -----] Septic Tank (Specify Requirementsl............ ... ---------------- -- .. . .............. --- ' I {� `� i— ` ------ --------- Disposal Field (Specify Requirements)...__I""S:_�) .�.V..�- ......11 ....--- i ---•.. .. ............. ........ --------------- -- ......------......... ------......I-- ----- ----- i 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 licensed agents signature certifies the following: I "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." ......:......Owner - ---- Of --[1f other than' owner) FOR DEPAJITMEN USE NLY APPLICATION ACCEPTED BY-------- --------- -DATE --------.__a.? . :_`. ...-.-.. - --- ---.... DIVISION OF LAND NUMBER--- ----=--- ------- -------- DATE ADDITIONAL COMMENTS------------------ ....- i ....... .................. .`._ ........... ...................................... -- ----...... - ------------------------- _/ ;; ' � ...--- - ,�-- Date.--- � J Final InspecTion b - - - . EK 13 24 SAN JO IN LOCAL HEAL DI CT Fas 21677 REV, 7/7C 3N