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FOR OFFICE USE: n 0- -------- --------. AI'ALICATION FOR SANITATION PI:RM17 - ----- . iComplete in Triplicate) Permit No. ___._-.._ This Permit Expires 1 Year from pate Issued Date Issued / Application is hereby by 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 ADDRESSILOCATION ___" r I-.` - ,��,i►,�Q:.._ - � .. ...CENSUS'TRACT-..--___"----••--------- Owner's Name -• ---- - _ _ � � �-e�.•�d•_--�------------------------------------ --------------------Phone Address -�c y > F------• .-4-e---------- --- City Contractor's Name ._... ------_--_License Phone"_ 7tw_ M �# Installation will serve: Residence J`i'Apartment House 0.Commercial OT tier Court 0 Motel❑Other............................................ Number of living units,_ ------ Number of bedrooms .__0L.-Gorbage Grinder ._7. -_-. Lot Slie __.._JJ -- Water Supply: Public System and name ------•-------•-------•-•----------------------------_...•----------------•-----•--•-_-_ --------------Private' Character of soil to a depth of 3 feet. Sand o Slit p Clay Q Peat j] Sandy Loam ❑ Clay Loam o Hardpan ne Adobe O Fill m,aterial------------ If yes,type----.-----.---............. ki (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) L4 NEW INSTALI'TION: (No septic tank or seepage pit permitted if .public sewer is available within 200 feet;) PACKAGE TREATMENT ( ]. SEPTIC TANK[ I Size--------------------------- ---=-r._.._.-...... Liquid Depth ...._..........._......... � Capacity _-_------------- Type -------------------- Material-.....__..___---__-- No. Compartments � Distance to nearest: Well .....-....._..____ _____ Foundation .............Prop.Line------•----------_-•- .LEACHING LINE No, of Lines --------/------------ Length of each line--.----- Total Length ------- jr-�7__--.. 'D' Box ....� _ -- Type Filter Material f� .Depth Filter Material --.----��_�!.................-�- �y i T Distance to nearest: Well ._..=c�!'__Q...... Foundation / Property Line PIT ' De J r 'f` pth SEEPAGE ---- . --- Diameter ___�tf-- Number ------------ .-. ..... Rock Filled Yes 10 No b Water Table Depth ............. p_--__ --- -----_-_--Rock Size _____-------- -------••___-- f • Distance to nearest: Wel ..... :...:..-:.�:::.-.faundot�on __-f � Prop. Line _.4.5rZ.f REPAIR/A0Ii1T1ON(Prev.Sanitation Permit ......... -------------------------------- Date ----------____-.......... ....__.l Septic Tank-(Specify Requirements) -•--•................ -----------•--••--.. .................. -----------------_--.-...-=-.-_ ..........-.W----............ Disposal Field (Specify Requirements) /i ............. --------------- ------------- ...............--........................................................................................... ' (Draw existing and required addition do reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Otdtnances, State Laws, and Rules and Regulations of the San Joaquin .Local Health Distriet.Hem* owner or licen- sed agents signatura certifies the following: "I certify that in the performance of the work far which this permit is.issued, t shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.,, Signed -------� .. Owner r . 8Y ...........__. litle _.. If other than owner► - �� FOR DEPARTMENT USE ONLY APPLICATION.k ACCEPTED BY--- -- ---- --------------------•--------------------•------• -•_-----•---•-••-•---• - DATE - � '°lL-------------•------- 8ilILDIhOG PERMIT ISSUED,__ x a �.� --------._r�,-_----..----___ _-----•-� --.SATE - ADDITIONAL COMMENTS---•-•-----•----•---.._...._ ------------ ..............................................••-•---•--------------------..-...........--------- ._....-------------•-----------------............-----.---• ----•----. ..............•-- • •--------------------•-----..._...---•-----.....---........_....------------------------•--- Flnal Inspection by: ---------- -----_-Date � SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1.1468 Rev. 5M