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__. OFFICE USE: I APPLICATION FOR SANITATION PERMIT )'isr OR + ---- ---------------------- Permit No: ---Z=----------- )13Q {Complete in Triplicate) Date Issued ---_-----------------------------_-------_-------- This Permit Expires 1 Year Froin Date Issued - 4 ems— 3tO ---(D �D A/ - rti 16,r-L r)14-�/ '-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/LOCATION -(a!?/`,--- fl�Lr - - NSUS TRACT -------------------------- Owner's Name ------------- -------Phone V�C� Address � � p —1111 --6�`---------------------------------------- City - i�l�=fi t Contractor's Name --- ----- Aa ---------------------------- -------License # ---------:-------------- Phone Installation will serve: Residence ❑Apartment House°❑ Commercial XTrailer Court l❑ Motel ❑ Other ---------------------------------------- • Number of living units:_'"-'____ Number of bedrooms _I.......Garbage Grinder�/,P- Lot Size - ------�------ ------ Water Supply: Public System and name ---------------------------------•-------- ------------------------------- ------------------------------- PrivateX Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Z Hardpan ❑ AdobeX Fill Material ------------ If yes, type ---------------------------- Q (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 [ ] SEPTIC TANK X Size_�}I` _X - - _________________ Liquid Depth�0-- --------------- Capacity - .________,_._-- Capacity 1.2ee-.___ Type Material_t 3= f-- No. Compartments ---2..�----------- Distance to nearest: Well ___ _ _ ______________Foundation __________ Prop. Line _____... LEACHING LINE No. of Lines ----/--------------- Length of each line--ef-11-----------.__ Total length4?10- '------_____.____ 'D' Box 4/'e_ Type Filter Material __ is%'_.Depth Filter Material /AAPS --------------------------- Distance to nearest: Well _Z0_,(7— Foundation � _�_______ Property Line - -..__.. SEEPAGE PIT 4(J Depth ____ Diameter 14J2xJ21`___ Number ----_l'------------------- Rock Filled YesZ No ❑ Water Table Depth t.�---- ----------------------- Rock Size _.P- ------------- , ................. f Distance to nearest. Well _.__ ___ -- ___....:_______Foundation _, — ______ Prop. Line ,,�Ca............ 1 REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ----------------------------------) Sep#ic Tank (Specify Requirements) :k --------------------- ---------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ----------------------------=------------------------------------------- ------------------------------------------------------------- 1 (Draw existing and required addition-on reverse side) { 1-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. Horne owner or licen- sed agents signature'certifies the,following: k "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-Corrpeniafion law's of California." ,;,Signed Owner �� BY ------------ ------ _ {" Title � F ` f other than owner) ' + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- �---�-------------------------------------- DATE __ f 5 BUILDING PERMIT ISSUED ----- -------------------• - ----=---------------------------------------- ------------ -------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------------------------k..----------------------------------------------------------------------------------------------------------------------------- .- / - ----------- - ---------=----- - ----------------------------------- - ----------------- ---------------------- -------------------- -DateFinal Inspection by: --- - ---- AQUIN LOCAL HEALTH DISTRICT - - �. F H 9 I-'Aq RPv- SM .r^�`