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FOR OFFICE USE: APP!lCATION FOR SANITATION PEWIT - ) i'— (Complete in Triplicate) Permit No. -------------------------------------•-------- This Permit Expires ! Year From Date Issued Date issued yzc—Jy Application is herebymade to the San Joaquin e work he described. This appliation is made in compliance with eCountty District0 dinance No. 549 and ex s ng Rulestalndt Regulations-.e'n JOB ADDRI S5/LOCATION, 7 - CENSUS TRACT - ~- Owner's Name - 'r Phone —__ _-.--_ Address `'S ``' •---------------------- -- City =------------------------ •-- Contractor's Name ---fY,C� ------ ' --------------------License #�. .�FIs Phone Installation will serve: Residence JE4 Apartment House❑ Commercial❑Trailer Court Motel IN Other _ Qc�J----------------- -- Number of living units:--- ------ Number of bedrooms ----Garbo e Grinder _-,-VD--- Lot Size ----7f ------------ WaterJ J. . Supply. Public System and name ---------------------- ---------- _____.-_Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam A0 Clay Loam.0 i Hardpan ❑ Adobe [] Fill Material ------------ If yes,type ---------------------------- (Plot --_-_-------------(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 if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK F _ Size_ ------------- Liquid Depth -----`------------- Capacity� tl� Typ , "" Materia � Na Compartments - -_--:. - _ f. r Distance to nearest: Well /_0_1 Cd------------------------Foundation -__._--_-__._ Prop. line _- .._._-_____. 0 !� LEACHING LINE No. of Lines ----------------------- Length of each line------'9.�---------------`Total Length1-70----.____-.-.__-- 'D' Box ,1�] Type Filter Material _ /K.-_,Depth Filter Material ---/-,f- ....+............................ Distance to nearest: Wel! -_- c'?--`-_-__- Foundation % -_-r_._----- Property line �- .............. z SEEPAGE PIT Depth _-- 0-___ Diameter _ _` Number ----_�-------------___ Rock Filled Yes No 0 r ' Water Table Depth _- ' } ------�---- -------------------------------Rock Size -��--.A'--�..-�------ # Distance to nearest: Well es----------------------------Foundation -_AZ:>�`---- Prop. Line .-,�.�......._._ �" �^* REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------_-_____--•_-) r Septic Tank (Specify Requirements) ------------------ -- 1. :Disposal Field (Specify Requirements) .------------------------------ --- -------------------------------------------------------------------------------------------------------------------------------=-------------------------------------------•-------------------------- (Draw existing and required addition on reverse side) r 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: r- "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 -------------------- ----------------------- By --------------------- ByOwner ------- r ---- ----------- -----------. Title ---- ---- -----------------------------(If other than FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---- - DATE " --•- -------- BUILDING PERMIT ISSUED ----- ------ - ------------------------ ----------------DATE ---------------------------------- -- - --------------------------- - -------- - ADDITIONAL COMMENTS -__------------------ - - ----------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------•----=-------------------- - --------------------------------------------- ------- - - - ---- ------------------------ ----------------------------------------------------•----------------------------- Final Inspection by: --- --- - ----------------------------------------------------------------•----------- ----- -s '�g -�-'t-----:r - -...---Date ---•------ ---- -- ----------------•------• r VVV SAN JOAQUIN LOCAL HEALTH DISTRICT L tO E. H. 9 1-'S8 Rev. SM