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�/ APPtICATI.43N FOR SAf+I1TATECtIe1 PERMIT (Complete In Triplicate) Permit No. ................<..., ------------------------- -----------•---_-.- This Permit Expires I Year From Date Issued Date Issued ' l/J .. 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/LOCATlFit O ..f. ._•.".�_-- .!V_ !rt_... _._...... .....I`�'1.....D�ti ....CENSUS TRACT ............................ ��------ Owner's Name �� -r'L.. _-..----•----•*•............... ....................Phone ..._��._� EAddress _134--l?... ........................................._.._.city .... ._._�.:.. c. Contractor's Name ...License ,l�`'6 ./... -- .. Phone Installation will serve; Residence`s Apartment House] Commercial ]Trailer Court 0 Motel-[]Other-----------•---------------- -------------- r i Number of living units:-....I..._ Number of bedrooms _.._....Garbage Grinder ...........- Lot Size . ................ Water Supply: Public System and name _-._ .. Private { - Character of soil to a depth of 3 feet: Sand n Silt Q Clay. ❑ Peat❑ Sandy LoamGay Loam Hardpan p Adobe 0 Fill M6terial ............ If yes,type............... ............ f �f Vi (Plot plan, showing size of 'lot, location of system in relation to wells, buildings; etc. must be placed on reverse side.) C NEW INSTALLATION: (No septic tank.or seepage pit permitted if public sewer is available within 200 feet,( C i' PACKAGE TREATMENT ( 3 SEPTIC TANKM p S'ze..-_ .rX.. �.__. . Liquid. p �+ Capacity/ Type __LS��_. Material.. U__ No. Compartments y....._._.. r r - Distance to nearest: Well -------s- ......................Foundation ----lQ-............ Prop. Line .... _.- , _...• .. k 3 LEACHING LINE b, No. of Lines '..:--7�..=_..r__--- Length Of each line---....t�..r..._-.... Total Length ._ _ _.......... V Box ............ Type Filter Material;.!! .....Depth Filter Material ......./.a .............................. Distance to nearest; Well ....S52....._........ Foundation ----_/i'1.___7�-------- Property Line ....y....... SEEPAGE PIT ( 9 Depth -------------------- Diameter .--------- Number --..----.-.---- .._._. ----- Rock Filled Yes ❑ No 0 71 Water Table Depth -------------------------•----------------•-----Rock Size ................................ Distance to nearest: Well .____._Foundation ................... Prop. Line r REPAIR/ADDITION(Prev. Sanitation. Permit ` -•....:..................................... Date -_-.._..___--------:---------__--_) j. Septic Tank (Specify Requirements) ------.._.: Disposal. Field. )Specify Requirements( _--------- •------------------------------------------------------------------ I --------------------------------------------••--••............-- s --------------- --_- -------------------------- ---• -.:. ----••--••-•-----•---- -------------------------- ----•---• ............_. (Draw existing and required addition on reverse side) i- 1 hereby certify that I have prepared this application and that the work will be done in accordance with. San .loaquln I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HeaI&District. Hoene owner or licen- sed agents signature certifies the following: "l certify that in the performance of the.work for which this permit is Issued;l shall not employ any person in such manner } as.to become subject to Workman's Compensation laws of California:" r-1 Signed -------------- •---------- ----.-----=- -- -.------ --•-----•------•--------•----•--•------ Owner gy ` ----------------------------------- Title ---- ( oche han -�_t--------------------------------------- owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ t >....-------------------------------------------------------- •---- ...........DATE ---_ .. .� ------------- Ll BUILDING PERMIT ISSUED .-- - -----.-...._ DATE ------------------------------------------. ADDITIONAL COMMENTS _,1'�3- 6 __ �.:.. �r- %.... �'" a3`a` i ------------------ - --- 3 Finat Inspection by= •-------------- -------- D .. ---- . lEH �3 24 1--bli }leve 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M � t .