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FOR OFFICE USE: " ...... APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ...7.`��__ .......... :... ............. ....... . ..................... This Permit Expires 1 Year From Date Issued Date Issued ..g:' ...:....� ' 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/LOCATION � C9SGcJG ..... - '.............CENSUS TRACT Owner's Name ........ � -1✓`� �._ _ L.-.. ...........Ph d' ' Address .......43-1,3-e :................ ....... ar ity Contractor's Name - ------.license # .......................... Phone .....------.....:. ............. ... .. ..............•-•-•--...-----•----......•. Installation will serve: Residence 0 Apartment House❑. Commercial FY01ler Court 0 Mote! her ....:.:............... } Number of living units: Number of bedrooms ............Garbage Grinder ------------ Lot Size .... -- Water Supply: Public System and name ` -------- ... ._.......__..!��..... .. _ Private Character of soil to a depth of 3 feet: Sand - _ --. � '°'"' BSilt❑ Clay D Peat❑1 Sandy Loam ❑ Clay Loam ❑ Hordpon❑ Adobe❑ Fill Material .... If Yes,type _ - (Plot pian, showing size of lot, locotioh of:system in relation to wells, buildings, etc. must be placed on reverse side.) r r, NEW INSTALLATION: (No septic tank oF.seepq pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC.TANK - f Size.•--•-•--•-----•----• liquid Depth .............. p y �_ Ca ocit �_ _ ...... TYP -� ----...MaterialA?r _ _ -"---- No. Compartments z ,.: . _.._...----•- .---- ..... I Distance tol.nearest• Well / Prop.- _ ----�D..?_`_.....-•--•---•�'--Foundation ---�...------- r r •- -.. t - _.. p. Line --------------- LEACHING LINE 1 Length of each line.��.�'......... ... _ �_..r,. f [ No. of Lines _. � .._ _ Total Length .....�•�.. 'D' Box -fid_. _'T. �e Filter Material . ! i Type Depth Filter Materia! ......./`�-•--•..........................6 ' Distance to nearest: Well ___ ................ Foundafiion - 'r�. -- _ : r --••-_--_- Property Line -. I � .SEEPAGE PIT O Depth ••l --------•-•-----•- •. .. Diameter ................ Number -------------------- ..... Rack Filled Yes ❑ No C]1 Water Table Depth ...__...._—:.------------------...............Rock Size _ Distance to i nearest: Well ............. •----•---•---...........Foundation ••---------- .... Prop. Line ......................REPAIR/ADDITION(Prev. Sanitation Permit# ....•-- ----...........................•---- Date .......:........ ._- Septic Tank (Specify Requirements):__..... 3.._-•-.'. ?`---------------- ........... ' Disposal Field (Specify Requirements) ______------- ?% --------- ---•- --- w ...---•- ----------------- --- ----- ............ (Draw existirtg'dnd 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 oUthe San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ! certify that in the permance of the work for which this permit is Issued, I shall not-employ any person in such manner as to becom s Workman's C e A`n laws of California," Signed X., _ _ ------- -- ... . _. Owner BY ..............:. ----:.._.. ------ - - ............ Title ..............._ (If other than owner) ...................................... .............. a FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ---- e,�V,G�-.,,.. 2 BUILDING PERMIT ISSUED ... DATE .._. - ��............. ------------------------••-----...----............•----_ADDITIONAL COMMENTS ._..._....-•- -------•.......................... ....... _ --------------- r ; --------------•-----•--•-----••-•-----•-------.._..-_••..- 11*.....------ I . . . .._.Date � ::::•Final Inspection bY - . ,, ........ SAN JOAQUIN.;LOCAL".HEALTH .DTSTRIGT. _ PY" 6.8_Rev. M..