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FOR OFFICE USE: , - APPLICATION FOR SANITATION PPItMir (Complete in Triplicate) Permit No.------------------ This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI ------ 7 ---- -------------------------- Z /---------CENSUS TRACT --------f ----- Owner's Name '? L----------------------- ------Phone - - - -Cri- - '_ � Address ... - ,_ _ F - Contractor's Name -- ..----- - ------License Phone _ / _ • -3/ ?� ---------------- Installation will serve: Residence Eg-Aportment House❑ Commercial []Trailer Court 0 Motel❑Other-------------------------------------------- Number of living units:---_ _ Gcirba _-. Number of bed kms .. Z7, Grinder ----------- Lot Size -----`-3--�--Water Supply: Public System and name -------- - ----------------------------------------------------------Private❑ � Character of soil to a depth of 3 feet. Sand"❑ Silt❑ Clay ❑ Peat[j Sandy Loam ❑ Clay Loam f] Hardpan❑ Adobe 9 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 flank or seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT f ] SEPTIC TANKX' Size__-/_�a?_X SX_ ________________ Liquid Depth ----� - Capacity �_____-- Type 4i�++ -' -- Material_--Cn__ No. Compartments ------s-- ------- Distance to nearest: Well c,�1_________-_•- -_--Foundation - ------------ prop. Line--- Q________-- LEAACHING LINE ' No. of Lines ------------------------ Length of each line------�L1 _________-- Total Length 'D' Box ------------ Type Filter Material 5=_d r Depth Filter Material ______- _ 1' V Distance to nearest: Well ` - -11_�l..`�--__-�-- Foundation __ate_____________ Property --------•-------- SEEPAGE PIT "' Depth r _------- Diameter , ------- Number -------------/-------- -- Rock Filled Yeso-- No ❑1 �.� Water Table Depth -•-----------4_:p---------------------------Rack Size -------------- Distance - ------Distance to nearest:-Well "f ?- _r.._-.__•_ "�,� f Foundation --- -- --------- Prop. Line __ ------____-- REPAIR/ADDITION(Prev, Sanitation Permit-#------------------------------------------_ Date ----------------------------------) Septic Tank (Specify Requirements) -•-------'---------------------------------------------------- - DisposalField (Specify Requirements) ------ ---------- ------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------- •-•--....r �---•-- tax-�11 l.Li� ------'�------ -------------------------------------------------------- •--•------------------------ ------------------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that I hay* 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. "1 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 5 blect to Wor n's Comp sation laws of California" Signed .............."�}� ... 1r�l----- ��/ � . r ------ ------ Owner By ...__.--` ------- .: -- Title other than owner) TMENT USE ONLY APPLICATION ACCEPTED BY........ �- ..---- -- - -- --- ---- ----------------------------------------------------• DATE -----�--��-...��------------- BUILDING PERMIT ISSUED .----- •-••-----=-_-- ----- ADDITiONAL COMMENT =7�..... ...... r �. - _ _ . - --- ------------1-1-.-.-_-_---_-1--_-_-.---- -----------•-- ..............•. •--- _- Ffnaf Inspection by: ..._.__..... ---------------------------.Date SA JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'b8 Rev. 5M