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FOR OFFICE USE: ii. '`,PPLICATION FOR SANITATION PER. 3 S` ------------- - Permit No- --— - ------- (Complete in Triplicate) ------ ------ -- -------------------------- Date Issued __-- ---. _ __---- - - „ _ _------- This Permit Expires t 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 Ordinance No. 549 and existing Rules and Regulations: V / JIVE JOB ADDRESS/LOCATI'ON ../-_9. .. fA_,--�,_._Zr .0 ,-/� -r- � D-- .........CENSUS TRACT .....45.-- -_---- Owner's Name -----wiJ'Qt"►1IES----�L9p��-�A�,.J�--------------------------------'-------------------Phone ------ ---------- L Address ..l-- I It �_ U _J'i--oslll r- - - - city ��s'� C.r !9c'/f, <i�` ----------- Contractor's Name .- �_X, � -- - - - .License # -�4� Phone� 0 ` Installation will serve: Residence ❑ Apartment House❑ Commercial [-]Trailer Court ;❑ Number of livingunits:.... Number of bedrooms -_.._._..Garbage Grinder _. .- Lot SizeIyS Motel ❑ Other .__ I V Water Supply: Public System and name - --------------- --------- - - ---------------------------------------------------Private 91� Character of soil to a depth of 3 feet: Sand'[�ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material __._ ------ If yes,type -------- -----------____-- r (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-seepa a.pit permitted if public se er is available within 200 feet,) / ` ii Af L� PACKAGE TREATMENT [ I SEPTIC TANK ,�j �SiSizz�e-/ 3_!r _�a --- Liquid Depth _ Capacity✓'�QO----- TypAF___2AW MatericiazA `eY`'C.! No, Compartments _ .... . . 0 i f�� Distance to nearest: Well ...9Q__...--_---------------Foundation _S["...__..___..._ Prop. Line i / LEACHING LINE LP( No. of Lines �---------- 7_. Length of each line___/tom- --.... .__:- Total Length /7"o................ /� s ii 'D' BoxyFS--_ TYPe Filter MateriaNXk_-_f!_._.--Depth Filter Material �_�..._._-_- \ _. Distance to nearest: Well /47,3----------- Foundation _7 ____._......_ Property Line .1/10_______________ SEEPAGE PIT '[ 1' Depth -------- --------- Diameter _.._.. -------- Number Rock Filled Yes ❑ No ., Water Table Depth I-------------------------------------------Rock Size --------------------------- v Distance to nearest: Well ----__-------------------_----------Foundation -----_ ------------ Prop. Line ...__..._.____.._.-- REPAIR/AD (Prev. Sanitation Permit# --------------- ------_ -------------------- Date - --------------------- ----------) Septic Tanki(Speafy Requirements) ------= + ------- - --------- --------- - - - ---- ---------------------------------------- Disposal Field (Specify Requirements) '------------------------------------------------ ------------------------------- I -- ----- - - - -------- ------- - ---- ---------- - ---_...--- -------- --- (Draw,ezisting 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 t` as to b1come subject to Workman's Compensation laws of California." Signed!- --- - ------- ---- - --------------------------- Owner � (If cher Thdn owner - -- --------- Title _.�IC40j.=1e. ../Fx - jR DEPARTMENT USE ONLY L APPLICATION ACCEPTED BY _ TSI:3_0,--------------------------- -------------------------. DATE ------- BUILDING PERMIT ISSUED ------ --------------- --- - - - - --- DATE .----- ---------------------------------- ADDITIONAL COMMENTS_-- -- _._..__ ------ - ------ ---- -------------- -1 - - -------- ---A -- ---— - - -- -.-------------------------- ------------------------ - ------ Final Inspection .—_ - ---- _-Date _" `� �-( SAN JOAQUIN LOCAL HEALTH DISTRICT LATE 11, Page 3 Of 16 C U A l..IAD Do•. r.AA - _. Qfc-)-