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FOR OFF ICE USE: , APPLICATION FOR SANITATION PERMIT .........................................:......... Permit No. (Complete In Triplicate) - This Permit Expires 7 Yoor 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 Regulationst f 'f fi a .�.. r � ie?- oso-03 JOB ADDRESS/LOCA1! Llf ..G� 1�/. 5 TRACT . .....................•-- N ....._. ::... , . Owner's Name "' l..! .... . - :............... .....Phone .. Address ...... .... ................................city / .. ��.. Contractor's Name --_�C; r ,� >�� ,.4xv`-tAA4_ .,License #art�C. 7. Phone !��°�..ZQ.� Installation will serve: Residence Apartment House 0 Commercial(]Trailer Court 0 y Motel ]Other -----------------------------------•---•-- Number of living units:_.___._.. Number of bedrooms ...Garbage Grinder� __ Lot Size ..._ --0_. � ......... I WaterSupply: Public System and name --•----•----•-------•-•---•.............•------•-------------......-- ................................... ....Private Character of soil to a depth of 3 feet: Sand'] SiltC] Clay o Peat❑ Sandy Loom ❑ Clay Loam ❑ Hardpan Adobe Fill Material ............ If yes,type ...... (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 seepage pit permitted I# public sewer is available within 200.feet,) PACKAGE TREATMENT { ] SEPTIC TANK ] Size_.-.. Liquid Depth ... Capacity ... 'Type 6WVMaterial�_ 46ENO Compartments Distance to nearest: Well ....._ ..- ......Fo%afro ..../0......... Prop. Line ...................... LEACHING LINE No. of Lines Length of acct line...___i .... Total Length _.. 'D' Box ... Type Filter.Material Depth filter Material ............ ...... ... ,✓ Distance to nearest. Well ....�. ..�_. Foun ation ------- /0.......... Property Litre .......................5 SEEPAGE PIT ( j Depth ---- Y...... Diameter i- ..... Number ............ ...../.. ,-- Rock Filled Yes No ❑ Water Table Depth --------- I ...Rock Size ...... ............. Foundation ....... Prop. Lin® Distance to nearest: Well ..........��----•----•_-•-- .__-- --_-_-- ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----•--------------------------------------- Date ................._..............A Septic Tank (Specify Requirements) ........... r Disposal Field (Specify Requirements) ........• -------------------------------------------------------------------- ----------------------------------------•-----------------------------------------------------------------------------------.--------..----•-------.---------------------------- ........................ ------------- ..........-------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared thls 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." t Signed'.`----...................-........------------ ------- -------------------- ............ Owner Title ....._._ .. _BY (If other than owner) FOR DEPARTMENT U ONLY APPLICATION ACCEPTED BY -------------- . ..... DATE ...-%G-/ -Js:_-..-------------- BUILDING PERMIT ISSUED ...................... ----- -----DATE _.._...........--------------.._..........- "' *...... ..........- ADDITIONAL COMMENTS ------• -------------- --------------• ................ ---•-••---...sl. .._.. ---...._....._..;.. ------------ f //.1� _:E...� .._ �.....1a.:!',��. rf ........- -- - - ------. .. ..................... .................................................. ---..................-•-•--......---•--•---•------ FinalInspection by: ........................ .................................................... DateSr- EH 13 2h 1-$13 itev. 5m SAN JOAQUIN .LOCAL HEALT TRICT 8/7h 3M