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R FFICE USE: 7�3��°�° , , APPLICATION FOLD SANITATION PERMIT ----- ---------------- -------- ---------- s (Complete in Triplicatel Permit No: Ba- ------------------ This Permit Expires 1 Year From Date Issued 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 .:------ -7 ----------------f/� /J1DyI/T--_-5/_ ---------------CENSUS TRACT Owner's Name -------------/) 1 ----------1- tw--&4-0//�---------------------------------------- ----- -Phone -. BS Address -- -0'&_5-0. _e -----I-If-3-AI ---------------------------------_- City ---------- ------------------------- i Contractor's Name ----------------------.License # -------- ------ Phone --------------------- -------- Installation will serve: Residence ❑ Apartment House-[] Commercial'❑Trailer Court ❑ Motel ❑Other ----- /*y 1 Number of living units..---,/---- Number of bedrooms _______Garbage Grinder 4/e--- Lot Size _ZQ_- Cid ------ Water Supply: Public System and name _______________ _-______________________Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ . Clay Loam :❑ Hardpan ❑ Adobe10Fill Material ---- ------ If yes, type ___________________--______ k (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 ta.nk or seepage pit permitted if public sewer is available within 200 feet,) i `j► PACKAGE TREATMENT { ] SEPTIC TANK • Size_1X_9,Y/ - --------- ---- Liquid Depth -----Gd_1_._L�....... V Capacity f 0 ype�/"Q�ateria Compartments _____ T � t Distance to nearest: Well ___V___U____________________Foun�dyation _ �- _________ prop. Line __ G_.._ _:________ LEACHING LINE �No.'6f Lines ___. ------------- Length poof��e,aac�ch� ii ______(-d------ ------ Total Length D' Box __l __ Type Filter Materi� 'Y`" �� / J _ Yp --------Dept Filter Material -------6--- ---------------------------- Distance to nearest: Well ------------------------ Foundation _____________ _________ Property Line --__-_________-___-----_ SEEPAGE PIT -J-j-- Depth -------------------- Diameter ---------------- Number ---------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------- ----------------- Distance to nearest. Well - -------------------------------- --Foundation --------------------- Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) - ------------------------------------------------------------------- ------------------------------------------- Disposal ----------•--------------------------- ;Disposal Field (Specify Requirements) ------------- ----------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- I--------- -------------------------------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 Son 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: "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-Compensation laws-of California." Signed --- ----------------- Owner BY sf'V`' --- -Title --------- (If other than owner) I l I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY;--- ------ ---------- DATE BUILDING PERMIT ISSUED -D TE --------------------------------- ADD�TIONAL CO . ENTS ' � 1-s t �� ' s--.--- rf_�1 -1r.. ' 0- '" =fid ex------------- _.____ r �----------� �1,r ------ Final Inspection by: ------- E__ _ tea.------__ - - -----------=------- ------------------------------------•----------;-4 — --------------Date_ �----------. SAN JOAQUIN LOCAL HEALTre, DISTRICT E. H. 9 1-'6B Rev. 5M