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� y FOR OFFICE USE: APPLICATION FOR SANITXTION PERMIT .................. Permit No.JY (Complote th Triplicate) .......................................................... This Permit Expires Date Issued ?r:.. . ..................................................... p res 1 Year From Date issued 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 ,:....... . C�..._,. _...... ................... , ,S C--7 _. _... ..�``----•----•.....------��-��.:.. C�NSlJ5 TRACT _.-��.'..l........: Owner's Name ._...._..-• � 1•----- �. ......-- .--••----.. ...................Phone .......... ........................ Address �� - • ..............2.7_1.......FR:n.... i� 1-._�......_..._..... City ._. 'T` �} .... ............................. Contractor's Name ...._-_--Ow- P.-L....I................ ..................' ........License # ........................ Phone . ........................ Installation will server Residence portment House❑ Commercial ;❑ Trailer Court 0 jMotel ❑Other ...............•- .......................... Number of livingunits:..-__.t__... Number of bedrooms .. Garbo e Grinder ❑❑��- ------ �_5 Lot Size f;�6��-'. . Water Supply: Public System and name .................. ••••. .................:. ......••-•-••••-•-••..........:.......::....•--....... ._._...Private _. to [�� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay b Peat Sandy Loam Or Clay Loam ❑ r " ardpon ❑ Adobe.0 Fill'Nlaterial _ _ .... If yes,type............................ Ir 3 i (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 spit permitted if public sewer is available within 200 feet,} - `f PACKAGE TREATMENT [ ] SEPTIC TANK,eepa Size.--... X�_ Xj.......... •Liquid Depth _.-- --- _........... Capacity .1 .._ PBEOSTMaterlal�O� __No. Compartments ..._. .._. Yp 0 , �, �. Distance to nearest: Well _._...�,:� --..........Foundation ....1.4"�:.::`� Prop. Line .... r LEACHING LINE No. of lines _.__ .__.____...- Length of each line..... ............... Total Length ....... / ......... r�I D' Box 1&.. 5 Type Filter Material :/70 IT)Filter Material ...._�_ ..........t�`:... i' Distance to nearest: Well .__ -- 'Foundation .._.I�_._..•._.._-. Property Line .. �r................ SEEPAGE PIT [ i Depth .._.-__ ........ Diameter ................ Number ---_.._...----._---•--_,.:_:. Rock Filled Yes ❑ No Water Table Depth .... ........•................Rock Size Distance to nearest:.Well Foundation Prop. line REPAIR/ADDITION,(Prev.:Sanitotion Permit# ........:................................... Date - ---- ........) h Septic Tank (Specify Requirements) Disposal Field (Specify Require'r4nts) ............ ................. ... .................. (Draw existing and required addition on reverse side) ; I hereby certify t 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. Home owner or licen- sed agents signature certifies the following: -- - -7 "I certify that in t e p orman'ce of the work for which this permit is issued, I Ia'I p not employ any person in such manner as to beco u ect Wor an's Compensation laws of California." { Signed ... .. ...... .- ....... �........................................Owner By ...................................................a................................................... Title ...___............................................................. (If other than owner) FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY ........... ........................................................................ DATE ....c.J:.. �.�: ............ BUILDING PERMIT ISSUED ................................ ...... •-----. •-----.DATE ............................ .............. . ADDITIONAL COMMENTS ... .. ......_....-- ............................. : . --- -- ............................................. . � x.....................................,. _.. _ " ...... .... . . .. . .. .._ ...._....... . . . . Final Inspection b : ................. - Date ....... •-•-----•---•-•----•-........--- -• ........----•••--•-.•-----. .. .. '„7,r_..... ....:.. ! SAN JOAQUIN, LOCAL HEALTH DISTRICT P u 13 24 1_-,&a De., ail * 7/7') 1 u F