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( 'FOR O'i?2_0SE: - '•�N` t�-�- �. APPLIC 11 ` SANIUT'IO.N PERMI .. FOR OFFICE USE: 3 flc� (Complete in.irial cate) Permit No---- �'---- --- -- This Permit Expires i Year From Date Issued Date Issued._.�_S S'-7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins�lll therwork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO L�1J928� F -- ------------------------------------ —'"�-=- ,,,, II � CENSUS TRACT --- - Owner's Name.._J! �__--- ! F----- ------- - �/ j/ _ ---- ----- - = E Phone Address--- .} a5 -s> -- ---- s -------- --------- ------------------- Cointractor's Name i - - S ---- ------ — License #_ / sJ one .�� Ph � Installation will. serve: ; Residence Ej Apartment House❑ -Commercial Trailer Court ❑ Motel ;Other---- ------=----- d Number of living units:-- -------------Number of bedrooms_ --___=___Garbage Grin Number Size- fl, - Water Supply; Public,System and name----- _. _ -_._ :._ I t-' i 4-. ' i - , l _...; _. -�_�:_-- ---- --- ----------------------- Private Character of soil to a depth of 3 feet: , Sand Silt Clay i o Hard an ' ❑ <, ❑ Y ❑ : Pei t❑ Sandy Loam Clay Loam ❑ p ❑ . Adobe.❑ Fili Mat tial__..--------If Yes, type --------' --------- (Plot plan, showing size of lot, location of system in relation fo wells, building' 'etc.'must be placed on reverie side.) NEW INSTALLATION: (No`septic tank or seepage pit permitted ifspublic fewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPT TANK x --�---- Li 1 ------00, � 4 ��, �r qu d Depth ____.. Size - --- J -- Capacity 3. TYpe `= ,�/ Mater p{. - -----------='_=-_-:---No. Compartments-----_ I e lj . r � Distance to nearest: Well-:. Q4:..- --------- :- -.-;Foundation.._ Q-----------Prop Line �_ X LEACHING LINE [ No. of Lines..__. `T ___ _ __ Length off each lins,r�df' ---..:-----------Total Len�gth.__3e `---------------------------- .'D' - ___ 'D' Box_./_._:__Type Filter Material%ifC ---Depth Filter Material__: -l- , ---: t x Distance to nearest: Well-_ :--_-_ .-----_- Found.. ation__ Q 4 --' ----.---.Property Lin SEEPAGE e---- r r , PIT ( Depth.-0;4 Diameter__ -- _- Number___:_- -- I Y = --- 0, Rock Filled 'Yes'E�' No�. ' Water Table Depth---- ------------------Rock Size_ Distance to nearest: Well---15Z __ ' f Prop. Line- -- _.------ - ' =--= ---- =------.Foundation..-_��_----- - - REPAIR/ADDITION (Prev. Sanitation Permit#________.__..__ . _-- --- - Date. ------------ Septic Tank (Specify Requirements)--------------------------------------=-- ----------------------------- ------------ -------------- Disposal.Fieid (Specify Requirements)_______________________ d -------------- ------------------------------------------------------------- ----------- • ------, --------- t - ----------------------------- - i --------------------------------- - - - (Draw-•existing-and`required,nddition 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- Sari Joaquin Local Health District. Home owner or licensed agents signature certifies the following: V -x "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 becom ub' ct to orkm 's Compensation'laws of California.- Sign alifornia." ' Signed__ .Z1_ Own BY----- e� -- ------f t r Owner .:----- = Ti le- t (If other than owner) t g `FOR-DEPARTMENT USE ONLY` ' APPLICATION ACCEPTED --------- ------- --DATE. DIVISION OF LAND NUMBER-------------------___-- i - - - ADDITIONAL COMMENTS_3• -- '"'----------------- -------------- ---------------------- e. ---------- --- -r.; -- -- ---------------- ------------------------------- -- -------------------------------- ------ ---- ------- _ --------------------- Date ti Final Inspection bY:--- --- �--•--- - � - -- - -- - � - .- ~---- rl' - , EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas 2167eE' v. 7176 inn y