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FOR OFFICE USE; / APPLICATION FOR ;SANITATION PERMIT ...................................................... ✓® ` Permit No.JB (Complete In Triplicate) ......................................................... This Permit.Expires f Year from Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct dad Install the work herein described. This application is made in compliance with County Ordinance Na. 549 and existing-164s and Regulations JOB ADDRESS/LOCAT N . .... ..`. ........CENSUS°TRACT . Owner's Name ... -_....... _ ............ ................... ......_ .. ...`..Phone ......................... Address . l�� ` c - _.._ _ Gity ..... �. ",.. ••. ' 346S:.�9,. ?.. Contractor's Name __ _ � ..license �' �6...7�...... Phone Installation will serve: Residernce impartment House Commercial OTrailerr Court Motel ❑Other e f , Number of living units:._._... Number of bedrooms ..3_.....Garbage Grinder ... Size .,�C��'14......................... Water Supply: Public System and .: = ............. ............................................Private l� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay JB' Peat❑f Sandy Loam {❑ Clay Loam ❑ Hardpan ❑,.., � e,-'[ Fill Material's .r..... If es tYPa ............... ..._..._., �.� (Plot plan, showing size of lot, location of system €n relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted lf.public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK{G}— —Size...2 :X-S_-:k___;FA ... Liquid Depth ....4�.� ..y..._.__. �.- - U� ..Capacity/.�DO__`";Type _. � -.. Material---_-�Ct�-4r.... No. Compartments -- ------ {� I Distance to nearest: Well ______-J_ Aoi--_................Foundation ----1_0_.r........ Prop. Line --0.�.I_.__... I I r ,> LEACHING LINT: [C}�No. of Lines ,,.�--------- ------- Length of each line.-----ya..f........... Total Length ..1. .4..x.....--__-. y � ' '� p / 'D' Sox .�N... Type Filter Material :�.__!r�. '�-.Depth Filter Material ............................................ 44 6 Distance to nearest: Well _14-o--------- Foundation ....�_J__......... Property tine ............. SEEPAGE PIT Ck4 Depth �.5_ i '�- Number ._._ 3 ____.___- Diameter ................ Rock Filled Yes 40- No ❑ Water Table Depth ........10.../-----------------------------Rock Size ...... �`��z' '• • Distance to nearest: Well ....15-........................ ...Foundation --____--`5--r---- Prop. Line . ----_-_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __................................ ) i Septic Tank (Specify Requirements) ----------------------------------- ....................................-...... ••-•................................. ---............. . DisposalField (Specify Requirements) -------------------------_- -------------_----_-- .................................... _..._... ............... -----------------------------------------------------------Z-------------------------•- --------------•............---........................................••.................................... _ _-----------------_-`------------------•----•----......................................... r {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, and Rules. and Regulations of the San Joaquin Local Heal&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, t shall not employ any person In such manner as to become subjectWork n"s Compensation laws of California." F Signed ----------- ---•-----••--- - Own_er�"f � BY -------------- _-------------- ------------ Title ---ge—__.... J44 ................... other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- ...-----------...- -- -- DAVE ..-... -------• .--------.__. ---------------- ---------- BUILDING PERMIT ISSUED _.._...-- DATE ........................................... ADDITIONALCOMMENTS ------------------------------------- ----------------------------------------- •----- ----------- --- - --------------------------------- ------ ---- - ---------- - -------•...............----------------•----..----...• . -------------- ------------------------- r /.-y jlyd. ------------------ --------------------- - 41 ...--•--------- --------------- .... Final Inspection by --- •• ........ ----------------------- ........Date .... .. ... - ...�...._. EH 13 24 1-68 Re 5 SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M/