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FOR OFFICE USE: APPLICATION FOR SANITATION P IT - ...... .. - � � Permit No. 9S- (Complete in Triplicate) - ----- This Permit Expires 1 Year From Date Issued Date Issued-'..'�f- '9.... 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 CCountyy/O/rdinanc No. 549and existing Rule and Regulations: JOB ADDRESS/LOCATION . _--_ 1,T2�, lG.d!C�-_- ,(/� Owner's Name .. L�.�L' } l2.��-_--&----- — 1_Yk/ll - �/1-e EPhone Address . `dil. � - -G ?f J r---lea- ---------- City ----- - - ------ - - ----- / ------------------ --.--------_-_- ---.Contractor's Name -- - -------- -- -- - ---.License Phone � - � Installation will serve: Residence ❑ Apartment HouseQCommercial ❑Trailer.Court C] Motel E]Other .,Q,�n...�.. �/ '�:... 47o�V Vle'�7 Number of living units:__ Number of bedrooms -e_-----Garbage Grinder/ya... Lot Size Water Supply: Public System and name ..--- ---- ----------------- ---------Private 22,— Character of soil to a depth of 3 feet: Sand Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam" Hardpan ❑ Adobe ❑ Fill Material ..___---- If yes,type )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,) / Y PACKAGE TREATMENT [ ] SEPTIC TANK 1A Size---- fV VIX_107--------- -- ----- Liquid Depth _�J��---------------- Capacity Type��rr- .l�.� Material.,&One_- No. Compartments ----�L..-..-..._.--. Distance to nearest: Well ../3.0_x_ .Foundation Prop. Line -------- LEACHING LINE No. of Lines _p�&______.. Length of each line_ .S -�____. .. Total Length Q 6 Yl D' Box -1 7- Type Filter Material /6� _ -Depth Filter Material �Q_.-.--------_----------------------- Distancee to nearest: Well - L .�7 ._..__ Foundation 21 ..... Property Line _------.-. SEEPAGE PIT [ ] Depth ... ..- Diameter __. -------__. Number __..- ___.__...__ Rock Filled Yes ❑ No El ` Water Table Depth - ---------------------------------Rock Size Distance to nearest: Well Foundation ._-........__._. Prop. Line --------------- - REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------_.___------ Date ----------- --------------.-------) Septic Tank (Specify Requirements) --.... ..........-------------------------------- ------------------------------------- --- ----------- Disposal Field (Specify Requirements) ----------------------------- ------------------------ -----------...-------....---- -----------..__._------------...-_------------------------- --------------- (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: "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 - . __---- -- - ._-- -- . -- _-.- .---- _ Owner By --- - ._ r--- -� - ---- - - Title ..__.__ �Il . (If r than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BYI —7--- ------- --- ------------- DATE _o�.'s3 C,-7-- ----------------- BUILDING PERMIT ISSUED - --- - -- ----- ------------- ------------ --- - ----------- ......DATE ------ ------------------ - ----- ADDITIONALCOMMENTS ....- ...... -- -- ---------- --------------------------- ------ ---- - --- -- - ---------- --------- --------- -- - - - ------------------ --- --------- - --- - ---------- ---- ------------- ------- - ------------------------ ----- ---------- ---------- -------- - --- - ------ ---- -- --- - -- -...- — ----- -- -- ------ --------------- --- - ----- ------ - -------- - -- - - --- Final Inspection by: ---------------- - ---------------------------------=---=- - - - ----------Date -----5.--- '--g-------------------- SAN JOAQUIN LOCA HE H DISTRICT