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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -3/ ................... ..........................I...--- Permit No. .............. IComplete In Triplicate) This Permit Expires II Year From Date Issued Date Issued __.:T............... Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinan No. 549 and existing Rules and Regulationss JOB ADDRESS/LOCATION ........ _. /-.��/� �f•` ........................CENSl1S TttACT .......................... / Owner's Name ...... �,--... !<l/. .. ........................... .............,......Phone ................................. ... Address f,--, .._. / _ ....... city .......Lf.... - Contractor's Name -•-- --- -------------•---•-•D .............................License i# Phone ..........,.t=t....... Installation will serve: Residence 0 Apartment House 0 Cgmmercial OTraller Court 0 Motel ❑Other ............... Number of living units:---....__ Number of bedrooms __ :..Garbaga Grincler,�,_<> Lot Size,/.... � . Water Supply: Public System and name ..............................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[] Sandy Loam 0 Clay Loam 0 Hardpan j] Adobe 0 Fill Materlal ............ 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 tank or seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT j ] SEPTIC TANK Size..._.'�,�..��'.,JZZ ........... Liquid Depth ._ . T Capacity _�° ?_�_.. _ Type�� ... Materlal[CzL Cn�--- No. Compartments . ............� s � Distance to nearest: Well ....... a..................... Foundation /.®................... Prop. Line .. ..................� LEACHING LINE V No. of Lines ................ Length of each ........... Total Length /eqf........... ,D 'D' Box _ °..._ Type Filter Material .4-A-C.-k- Depth Filter Material J Distance to nearest: Well _S�........... Foundation Property Line Ac_�............... SEEPAGE PIT Depth .__ ......... Diameter Number --------/................ Rock Filled Yes o (] Water Table Dep D ....................Rock Size ..1%.. ........... Depth _____.-_1�....�-.--•------------- Distance to nearest: Well ........./_0-!_.....................Foundation .-/.. - ........ Prop. Line . 5'z.......... REPAIR/ADDITION{Priv. Sanitation Permit# ----------------------------------_-------- Date -------•--- ................... Septic Tank (Specify Requirements) .. ........ Disposal Field (Specify Requirements) --••------------ .__...... _ _ .. __ _ . /74- -- ----- ----- Y ..-._..-.-...---------------------.._.__.-.-...........................� ___ ________________________ _ _ _ _ ___ ---_____-_-_.__---_-_--.........._............__._.__ ..._...__.._..___..___........................................ (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 Son Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local HeaII&Dlstrict. Home owner or licen- sed agents signature certifies the following: "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." Signed -----------•--... ..... ................... Owne BY ------------ ----•------- -------------------------- r t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- = -- -•-•- ---------------------------------•------------------------- - .. DATE -. 7 .7.-.._..__-- ----- BUILDINGPERMIT ISSUED ------------------------ -- -----------------------------------------------------------------------------DATE . ----------------...----...---•-----••---- ADDITIONAL COMMENTS ---------------------•--•- •------------_---------- ... -----------------------•--------------------•------ -•------------ ----------• ----------------------------------------------------- ----•---------- ............................................ Final Inspection by: ..........6.. '-- �)_AX ---• -------—- ----..._..---------- •----.._... •----•--_...EH Date ...... ..°� ---------- --------------- 13 2!� 1-6fi Rev. M OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M