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AOR OFFICE USE: . APPLICATION FOR SANITATION 'PERMIT .....................................................�--- Permit No. I ..:77..--..... . j ' (Complete in Triplicate) ........................................ Date Issued ...5:..7'- y .................................... This Permit Expires Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construcT and install the work herein described. This application is made in compliance with ouunt t�( r (Hance No. 549 and existing Rules and Regulations: ;. ,.. .. CE ACT IOS ADDRESS/LOCATION Ql. ,lJ' .f�.�1/__l.!_.�T . .--. j.......-./'. ............. CENSUS TR Owner's Name ..�� ..� ......L _ �..C... .... 1 ....-?............ ...--..Phone ... ....................... ....... i N .. CityY--/li Address l ..................... ..........License #c / - Phone . ........................ . .. ..fes .. .. Contractor's Name ....-: Installation will serve: 11 Residence ;��pcirtment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other .... ........................... Number of living units:...-I.-.... Number of bedrooms ..........__Garbage Grinder. ......_ Lot Size m ............... ....... .......'- Private i /'' •'l Character of soil to a depth�of 3 feet: Sand Silt 171 -Clay E] Peat❑ Sandy Loam fl Clay Loam ❑ � " Hardpan ❑ Adobeill Material 1.44 .. If es,type i Y e - --- -- (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side o septic tank or seepa pit permitted if. public sewer is available within 200 feet,) f NEW INSTALLATION: (N 1�- r PACKAGE TREATMENT I ]!F SEPTIC TANK za... •- t , ._:.<. Liquid Depth _... _..r jj n. ..-...-... _ .••-- ........ Ca'pacity`�1.��.�... Type _�... ..-..--- Materiai� ��No. Compartments �:: Foundation Prop. Line If Mance to nearest: Well ..�-------------- ' ...r ---................... No. of Lines -... Len th of each line..- - {� Total Leng �v LEACHING LINE - �- _:�. , g � " �-..._- , . .................... t 'D' Sox . Type Filter Material r!�.._.___Depth erlo ........................ I _ Filter Mat I _ Is - Foundation. ,= r e ................. istbnce`to nearest: Well _... .. Property Lin * Diameter Number ..-. .�...._ ._. Rock Filled Yes No Q . SEEPAGE PIT > Depth .� ......_ . _ ...,------ Water Table Depth ......../ .............Rock Size ............. .,---- - il Distance to nearest: Well ------f -----------•--••..--•--Foundation ....�.�...-.... Prop. Lina .................... 'I REPAIR/ADDITION(Prev. Sanitation Permit#' ....................._......-............. Date .................................. ' Septic Tan (Specify P p fY Requirements) ......................•._ . -- .... ....---•--------.....--.............._....._.--- -•----•---•- Disposal Field (Specify l�Regvirements) ............ ..................................................................... ..............--................................ 1i ------------------ ..................................... ........... - '-------------------------••--••-----------.....-.----------•--•-•--------------- Ih ........ ......... .....--- ... - ... - (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 "I certify that in the performance of the work for which this permit is issued, I shall not.employ any person in such manner f as to become subject to Workman's Compensation laws of California." ` Owner Signed ---------------- ---- -------•• _*..--• -------- -----.....--•------- � --- - .. --•-•..... BY ----...........----- .:5 . Title ... = f� ................ . o er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 'BY ...... - •• . . .----•----------------------------•----•-•----:..--- ........ --...- ....... DATE ...... .�. �' ................ BUILDING PERMIT ISSUED. DATE .......................................... I ADDiTiONAL COMMENTS '� --•• :.. .... :Date f :. :� .......••-- _ ....------. ••. fr-••••••- Final Inspection by: .. _ - --- "� SAN JOAQUIN LOCAL HEALTH DISTRICT MAL- 7/723X AL- 7/723 ,K ii ' r__ 14_13 241.'68 Rev. 5M