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FOR OFFICE USE: pp�ICATION FOR SANITATION PEF T r ------------------------ .......... -------------- --------- Permit No, �- ♦ (Complete in Triplicate) Date Issued 5��L--. ------------------------------------------ -- ____ - This Permit Expires I Year From Date Issued 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 Orrdinan a No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI --t2. --- - -- ./ / �✓---,q. --`----------------------------CENSUS TRACT .-.--......-----------.-- Owner's Norr Phone Address --- -- ---- - - ---------- ---- ----------------------------- -------- City ---- ...... .-------------- Contractor's Name - - ----------------- ---License / Jai Phone Installation will serve: Residence)dApartment House❑ Commercial []Trailer Court ❑ ff Motel ❑Other ---------- --------------- --------- Number of living units:---- Number of bedrooms S..----Garbage Grinder/ot> - lot Size dam- 6`/ evlvl,15r--- --------- .. Water Supply: Public System and name ------------- ---------------------------................._--------- Private Character of soil to a depth of 3 feet: Sand Elf Silt El Clay ❑ Peat El Sandy Loam E] Clay Loam ❑ Hardpan IST 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 sewer�is available within 200 feet,) ` �+ PACKAGE TREATMENT [ ] SEPTIC ��jjTANnnK Size _ - 1.J �-- -- - -- - - Liquid Depth................... Capacity/x90110------ TYp /`�' Material y !!°-. No. Compartments ---y�............... Distance to nearest: Well -_ ----- ----------------- -1P--._------ Prop. Line �... LEACHING LINE No, of Lines ..._17 . .......... Length of each line_- _- -� J _�._.-- ---._ Total Len th �-/ ------------ 'D' Box _ g Type Filter Material/ 44epth Filter Material---_............................. DistanPe tc nearest: Well .. �-_. --- --- Foundation .t ...----..- Property Line '> ''-�-----_ -9 4t - Fr SEEPAGE PIT Depth _arc_w------ - Diameter t� -_-... Number -----��.-_.-..--..__ Rock Filled Yes No ❑ Water Table Depth .--.-.- �-j_ _ �. ................Rock Size/��. -- -..-----.-- - ---- -- ---� / i Distance to nearest: Well -._ ��^r�....................Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ....................-:...................--- Date :-_-...._--__ .................... SepticTank (Specify Requirements) ----------------------------- _.......... ---.... ............ ..--------- -------------------------------------- Disposal Field (Specify Requirements) --- ---------------------------------------------------= - -------i-'--`--- -----------------------------------`--------------------------------------.-...-------------......-------- (Draw exsting 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 to Workman's;6mpon t' n laws of California." Signed ...---------------- -- ---- ------------.-..-_..-_ Owner By - - - --- - - Title ...__ EQ7� (If of than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-- -_�i_ w / -�a.Ngs�.✓e_l ----------------------------------- DATE .... - -• - f- ------ BUILDING PERMIT ISSUED ------------- -------- -- - ------------- - ...------ --------- DATE - ------------- ADDITIONAL COMMENTS ........ ----_------------------------------------------ -- -- ----------------------------- ------------------ --------------------------------- .......---- ---------------------.._....----........ .............------- --- —..... - --- ------- -- -- ---- --------------------------- ----- - - ----- ---- - Final Inspection by: --- - - Date _- .. 7 - SA17 N JOAQUIN LOCAL HEALTH DISTRICT e u n • •ce n_.. cu -