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FOR OFFICE USE. APPLICATION YOR SANITATION PERMIT ....._............. Permit No. ... '��.y ,........................................... (Complete in Triplicate) ............. :....................................................... This Permit Expires ii Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for q permit to construct and install the work herein described. This application is made in compliance with County Or 1 a e No. 549�an _ existIVg Rules and Regulations. JOB ADDRESS/LOCATION .6...1.1. :. :..... ... ........... .- _ ...... NSl3S TRACT .......... Owner's Name . ....--- •.Phone .,?.1..... ..`z� , Address .............................. .. -.---- ._ ». ..................____... _. . ity __.-. .......�°� _ _. ....__..._ Contractor's Name :............. ----.._........_..- -- ax ....................License # 2S' 3Y)___ Phone _�U::.14... Installation will serve: Residence E] Apartment use 0 4i.__ Number mmercial Trailer Court 0 Motel E]Other .............. .......of living units_____________ Number of bedrooms ___........_Garbage Grinder ....___ Lot Size . g.6.z _.)......... 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 ❑ Adobe sail Material ._... ------ If yes,type ............................ (Plot plan, showing size of lot, location of-system iri 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,) PACKAGE TREATMENT SEPTIC TANK Sjze... _ ..-•-------_ Liquid Depth....5.5 ...__.---•-•---- N- t Capacity f� ._. .._. Type ./ r '..... Materlal.. --- No. Compartments .�.......:...: 00 Distance to nearest: Well ....................................Foundation Prop. Line __�t.......... i LEACHING LINE No. of Lines ...-.� ............. Length'of each line..........5 .......... Total Length ...f .....-......... . Type Depth Filter Material -.. -�--�.'.................. 'D' Box ....._...... T e Filter Material ......- -.-••. .....---- ` Distance to nearest: Well ........................ Foundation ..... ....... Property Line :_ � ......... .� SEEPAGE PIT Depth ?��'_7�_�fI_ Diameter ................ Number .._..._ez�..___....._... Rock Filled Yes Na ❑ 1914r 1(► �it+u�S Water Table Depth ..----- ------ .................. .............Rock Size, P - - . 1. 1 �, .� ?•Z..._�.,��z-... Distance to nearest: Well .........................................Foundation -�_C�._7 ...... Prop. Line.•-r�................ REPAIR/ADDITION(Prev. Sanitation Permit# ......... ---------------------------------- Date .................................. ) Septic Tank (Specify Requirements) DisposalField (Specify Requirements) ...... -•........................I—....a_..........--•••-•••--- .........................------------------:...................... . ........................... ........... ...... ------- -.-------------------..............__..........._..._.......-•-•- --------------------------------------------------------- ........... (Draw existing and required addition on reverse side) _ 1 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: _ _ _ f "I certify that in the performance k fo of the worr 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 IL o- By ............. -------------------------------- _.___. . ........ (If of r Fan owner) . .............................---•-•--.................. . F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........��.. . _ - -------------------------••-....---••-••... DATE .......L1.! . > '�N t!?Q --••-_. BUILDING PERMIT ISSUED DATE _ .-- - . T. .. 6-g ...: . 1TS lr . ...ADDITIOL COMMEN •••- f ......0-1—t rewlz ........................•-•-•----._ .......... .... ---.-.- Final Inspection by . ... Date .: .............•.----.-•.--.. .... . , ,��,� _- . SAN,JOAQUIN LOCAL HEALTH DISTRICT rpt e u I_� L� 1