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y FO��AAOFFICE USE: APPLICATION FOR SA�'NITATION PERMIT r/ �' ...._.../__..i Yt!4:.................h- Permit No. .....T..� f {Complete in Triplicate) . ......._.__11.................................... Date Issued This Permit Expires I 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 applicotion is made in compliance with County ,Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION a` 136 -- ,� CENSUS TRACT .._.... �. . ..._.�,..'._ �•`'- Phone Owner's Name _S4.4^�-u�-_•� 1 ............... ....... r +_ , city .......... .............. Address _... ..... .. ........ r Contractor's Name ........_�"`� +a'o`"� .... --------------- .................License # 3_'� .... Phone'f �: � ......: .. Installation will serve: Residence M Apartment House-0 Commercial ❑Trailer Court C1 t ' Motel ❑Other ......... ------- ------------------- fLo Size .. �...------........................ Number of living units------- __-- Number of bedrooms :. -.....Garbo e Gri-nder ----- 1 Garbage I - Private Water Supply: Public System and name ...... - . } A`x CloyLoam Character of soil to a depth of 3 feet: Sand'❑ -Silt❑ -Clay ❑ Pea?❑'Sandy Loi m;❑ fl Hardpan ❑ Adobe❑ �� f Fill Material ... If yes,typeY_....____i._,.....- _i-.--- , hrl`. (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 publiczsewer is-available within 200 feet,) [ ] SEPTIC TANK ] Size-------------------•-•---------- --•-�.... Liquid Depth ................ PACKAGE TREATMENT :... 1 Capacity ........Type _-_ -•- - ---- Material---------------------- No. Compartments ---_-----.,....:.... tFoundafiion ...... ............... Prop. Line ............... Distance to nearest• Well �_ -. -- Length of each line �� f _ Total Length -{-------------••----•• �' r LEACHING LINE ( ] No sof es ............. _ ,r. ,,;•� �N. L ` -_` n _... - r .................. De th Filter Mate i61 ��' ......................R D Boxy,_.-=. T, a F�Iter Material �_.... p Yp � � �• € Foundation .... p;ty Linea .......-•------- Distance'to pe,01 st: Well .......... ............. .-----------.. 1frt SEEPAGE PIT j --,Depth-~-'�-�`R--� Diameter Number --•----...�.......= Rock-Pilled Yes;`[] o ❑ �. Water Table Depth :_ ••-----•........:...........Rock Size .. ....... -•-"-ti.3..��,;,1r� Foundation Prop.-Lir. vim`.............. Distance fto nearest: Well -----------------•-•--•-- --- I REPAIR/rADDITION(Prev. San ation Permit dry .... Date .............••-------- Septiz''iTank (Specify Requirements) -•--•-. .... _.. ..... II D - _..._ ...----- Disposal Field (Specify Requireme tsl ..._. --- _4---. ..--- ...----- t............... .......................--•----•....................... ....•------ ---------...._.. ---------.....--- ---- �. ..... --------.. ..--r.....................- y (Draw existing and required addition on reverse side) I hereby certify that I hole prepared this application and that the work will be dobe in accordance with San Joaquin art: County Ordinances, State'4Laws,fand Rules and Regulations of•Ihk1c�Joaquin Local Health District.'Home owner or licen- sed agents signature certifies th~e following: ` "I certify that in the performanceIof 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." 1 I. I - OwnerSigned ----------- ------- .. Title ! .... ........... •---.....-- BY -- = (if other ri owner) FOR DEPARTMENT USE NLY APPLICATION ACCEPTED ABY ....... .. . ..... ... • . DATE .. .�.. .. .... .... . . .................DAT ...---..:---•---.f.-...:: BUILDING PERMIT ISSUED - E 1 ADDITIONAL COMMENTS I ................. .... ................... ;............................... _....__.....__ •_ = = :.- . . ..----......Date . s w� Final Inspection by: I N JOAQUJN LOCAL HEALTH DISTRICT - --_ w � 7/723 M