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rUK Urric;e use: "PLICATION FOR SANITATION PER -- --- ----- --- ---------------- Permit No. _ ------------- (Complete in Triplicate) •------------'� -- .___-- 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 inst a wor erein described. This application is made in compliance with County Ordinance No. 549 and existing Rule and Regulations. ll//,,// -� JOB ADDRESS/LO _ TION/,7T�-4-- . ...............................................CENSUS TRACT ---------------- Owner's Name - - �^-----�-- ------------ - -- -- --- ------------------------------------------- ------------Phone -------------------------- Address ._ �. -1--1 R -`-- ----- -- ---- City CEO Contractor's Name ---- ... - �'� ---'� r - - nLicense # Phone Installation will serve: Residence RIIAp rtment Housef] Commercial ❑Trailer Court ;❑ Motel ❑ Other -------------------------------------------- J/ Number of living units:-----l----- Number of bedrooms ___..Garbage Grinder .._/-___.._ Lot Size _7"-5 ------------------ Water Supply: Public System and name ---------------------------------------- Cl---- --------Private {� Character of soil to a depth of 3 feet: Sand'❑ Silt E] Cl( (7Peat❑ Sandy Loam ❑ ay Loam Hardpan ❑- Adobe'❑ Fill ------If yes,type ---------------------_-__-. (Plot plan, showing size of lot, location of.systerrti in relation to wells, buildings, etc: must be placed on reverse side.) NEW INSTALLATION: (No septic tank o�r.s�'e ge pit permitted i pubblic/sewer is available within 200 feet,) PACKAGE TREATMENT SEP-TI /TANK ( Size ___X_1o___.i'.-s.____._.._.. Liquid Depth :__ ______________ Ca acit IOG4? _ s Type Material_ ,_ No. Compartments __C7;A.............. bistance to nearest: Well ..--------- Q--_-_____i__....Foundation ------/-t:_7---------- Prop. Line --------------------•- � i LEACHING LINE [ No. of Lines .__._A-.___....._ Length of each line....../_----_...._-._ Total Length _.__s (_90.._____-._ G ,. 'D' Box _. Type Filter Material __._ .___ _ ' Depth Filter Material ------ -1._---__-_ -.__-__--. Distanceo nEarest:•-W51 ---+ .-- foun --_ dation .__---- _........ Property Line ----J--____ __________ SEEPAGE PIT [ Depth -----;g-.__...___. Diameter _--�--- ..___ Number _____________ Rock Filled Yes ( No 0 Water Table Depth -------------------•--#-o'----•--•----------Rock Size _1_l, _.x_._a----•--•---• 1 Distance to nearest: Well ---------------P-0.0----------------Foundation ....... Prop. Line _... __.._.._.___.. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __.-_--_..._....______________.._-) Septic Tank (Specify Requirements) -------- ---------------------------------------------------------------------------------•------------------------------------•--•-------- DisposalField (Specify Requirements) ----------------------------------------------------------- ------------- ----------------------------- ----------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- - ---------------------------- ------------------------------------------------------------------------------------------- (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 kman's Compensation laws of California." Signed ......- .... Owner P ---- Y¢ Title ...-- ... BY _----------- _ - - - -H✓ ---------- ---- --- ------- (If of er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ------------------------------ --------------------- DATE. .`. -��--y BUILDINGPERMIT ISSUED ................ --_----------=' -----------------------------------------------------------------------DATE . ----------------- ------------- ........ ADDITIONAL COMMENTS ------------•--------------------- ' - ------•---- ---------- ----------- -------------------------------------•-------------------------•------------------------------------------- ------------------------------------------------------ --------------------------- -- --------- --------------------------------------------------- ----------------------------------------------------------------------------------------------------•-----------------------•---- ------------- - -- Final Inspection by: ,�-��- - - Final -•- ----- ------- Date -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M