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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT Permit No.. � ....r ...59� u v, (Complete In Triplicate) ... .. m Date Issued ../-. ...........7J.. _ This Permit Expires I 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 with County Ordinance No. 549 and existing Rules and Regulations: described. This application is made in compliance y t g �L� r.... . .. _.(, .�J& 4e NSLIS TRACT .......................... JOB ADDRESS/LOCA ION ��Z�': �' :._ .. .. - �[![..Q°-•`--t..... .... ... . - ....... .... .. .. here -51 �. Owner's Name .. City k�!![ -7.. Address ----_------------ .?.v. .. -- • ---- . Contractor's Name CT !1..=----..License # ....- Phone Installation will serve: Residence `Apartment House[] Commercial t]Traller Court 0 Mote ❑Other ._-....: ............... .............s • ' " ........Lot Size ... x Number of living units:_...�..... Number of bedrooms rGarbage Grinder /�• •......=••- I Water Supply: Public System and name................:......:.:.................:......�.----..._.........................---...................... private .. f * *, j Sandy Loam Clay loam ❑ Character of soil to a depth of 3 feet: . Sand❑ Silt❑ Clay '0 Peat❑ Hardpan-C]— Adobe[J. F#Ii=Material ..._...:... if yes;ty :...... . . Pa jPiot 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,) s rf 4 I SEPTIC TANK Size...--- -:�___�........................... Liquid' Deptfi .... -.rlG...._,...:... PACKAGE TREATMENT,. _ f' Capacity y ---- - Type -- ---•- - -:---- Material.L�`�`'G--` No. 1CO. partrrients ..... ... --- f/ .... .. Distance to nearest: Wel! _�.r. --....•......Foundation ...-.1 ..•=-----•-- Prop. Line ... ......:....'...� •-•--- i - f each line---...-- •••-- _ v LEACHING LINE No. of Lines Length oh 3Q .. Totai Len h ............ 'D' Box ............ Type Filter Material . -�!�.,••••Depth Filter Material ... /9.!........... i ......0 �r . _ r l.�..{..._. PropertyLine i Distance to nearest. Well or�_. " .... Foundation ........................ �. SEEPAGE PIT [ ] Depth .--:-_-_---_--- Diameter ______________ Number ......... .............. Rock Filled Yes Q No b - . Fou Water Table Depth Rock Size17 Distance'to-nearest:,Well ndation Prop. Line REPAIR/ADDITION(Prev..Sanitation i'ermit�# ' •••--•--- .... Date .................- _ ...______ -) -- I - w . Septic Tank (Specify`Req`uirements) ......... ..............:...........................................•,---•------__.._.......__.... r ...............:I •........... Disposal Field S eci Re uireents) ..-------•-----•-•..................................::.:—:__.•:_•_ -. I P fY m q _ = ....... ---........_..................................... -_ s.- `—'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 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 --------------_----- -- ----- .... . ..^.__. . ....----......L........................... Owner ' h BY ._._.....- ..... ---------------................ .Ti tle .- -_..__ ................................................. - (if-o er thdn`owner]•.f"+t FOR DEPARTMENT.USE ONLY L APPLICATION ACCEPTED 6Y .._ :_.. y..... : DATE..h;7.V-'y. 'tr............. BUILDINGPERMIT ISSUED .-----•-----------•--•-.._............... ..............:..............DATE ........................................... ADDITIONAL COMMENTS ......................................................................................... ..........•.......:..................... .', ... : ....... ................................................... .........---• ----- ,'. . - " ` .............. Final Inspection by: ....... .. • s ° ' rt .......................................................................Date ..... SAN JOAQUIN LOCAL HEALTH DISTRICT