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EOR OFFICE USE: "APPLICATION FOR SANITATION PERMIT C 3: 0-10 Permit No: _7&.4yV /-- ---- --------- - - lComplet�in Triplicate) / ----- Date Issued • _ _ This Permit Expires 1 Year From Date Issued install 'San Joaquin Local Health District for a permit to construct and Application is hereby made to the the work herein PP described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: TION _ ! , JOB ADDRESS/LOCA --- :L�d - = .` a -------------- ------CENSUS TRACT ---- -� ---- /; Owner's Name ------ VIM—n3 - ----I----------- --- ---Phone_-�.�-------•-----•--- --- I Address el r�--- ---------•------------------------• i - ��-��--� ... City - LA'�Y`t= ---- ---- Contractor's Name --�. 4 l L �`Y14.License # ----V- �r�_ Phone - installation will serve: Residence ❑ Apartment House^❑ Commercial ❑Trailer Court Motel ❑ Other ------------------------------------------- Number of living units:-__ ___ Number of bedrooms ------------Garbage Grinder ___---_____ Lot Size ---- _ __ I Water Supply: Public System and name __________________ ____ _ Private Peat Sand Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ Y Hardpan ❑ Adobe 'P' Fill Material ------------ If yes, type ---------------------------- showing size of lot,'location of system in relation to wells, buildings, etc. must be placed on reverse side.) [Plot plan, g � NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) •� I ' PACKAGE TREATMENT SEPT IC TANK [ } Size-----------•------------ --------- • - _____ - Liquid Deptht Ca acitl Type -------------------- Material---------------------- No. Compartments ---- ------------.---- iDistance to nearest: Well --------------------------• Foundation -------------------- Prop. Line ---------------------- No. of Lines ------------ Length of each line---------------------------- Total Length ---------------------------- LEACHING LINE [ ] ----- - i 'D' Box t-______---- Type Filter Material ____________________Depth Filter Material --------------------.---------------- f, I ---- Foundation ------------------------ Distance'to nearest: Well ________________"- Property Line ------------------•----- , SEEPAGE PIT � Depth __ �___ Diameter -" ��`1 Number --------------- Rock Filled Yes No Water Table Depth ------------1---------------------- --•--------Rock Size ---------� ------------ t /-------------------Foundation ---�Q__�-- Prop. Line ..- ---•-.-------- Distance to nearest: Well .___�L�O----- - IDate --------------------------•-------) EPAI ADDITION(Prev. Sanitation Permit# _______-.-'�------ Septic Tank (Specify Requirements) -------- --- __ -----�--- -----------"---------- -- ------------------------- ---- ------------------ -- f Disposal Field (Specify Requ reme ts) - r ---- -- ------=- - ------------------------ ----------------- --- ---- ----- - ------ -- -------------------------------------------------------------------------- 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,fand 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 subject to Workman's Compensation laws of California." i Signed _ J lOwner ----------- Title ---- ------------------- ----------- --- ---- ---------- -- --------- By ------- -------- (If other than owner) F p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ ___ _ -------------------_ __ ___ DATE __61`_ 7-1]------------- --------- BUILDING PERMIT ISSUED ._ = -------------------- -- ------------- DATE ADDITIONAL COMMENTS :------ -----•------------------------------------------------- -------------- --------------------------- ---------------------------------------------- ----------------------------------------------------------------------------------------------------- - - - - --- ----- ---------------------------- - - - -- - -- -Date --- --r---- �-------------------------- Final Inspection by: -- _-- ----------------------------- --- - ------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT �— E. H. 9 1-'b8 Rev. 5M