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f FOR OFFICE USE:.,. E PPLfCATlON FOR SANITATION PCAT ----------------- = 17 Permit No: .__,��J_�_.. (Complete in Triplicatel x Date Issued -- _�1"- ____ ___._-____._________ _._ .- -`-`:_____ -_,__ This Permit Expires 1 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: F4 JOB ADDRESS/LOCATIO �e-- '-sem CENSUS TRACT `` w,---------- -------------------------- Owner's Name -- 1------------ ------- - -- - - --- Address .------ - '� -------------- - City .t9 ----------------------------------------------------- Contractor's Name -----/-4-X_A��------------------------------------- ----- -- ----- License _ _ Phonecy-171 _ �-`�~ � Installation will serve: Residence �artment Housed Commercial ❑Trailer Court ❑ Motel ❑Other -----------------------------------•----- Number of living units:---/------- Number of bedrooms Garbage, Grinder ---`_ ---- Lot$iz .,,'_ ' -./ _.__...._- Water Supply: Public System and name _--------------------------------------------------------------------------------------------------------------Private [�}� Character of soil to a depth of 3 feet: Sand't__*_Silt❑ Clay ❑ Peat❑ 'Sandy Loa ❑ Clay Loam:❑ Hardpan Adobe - FiWMaterial ------------ If yes,type (Plot plan, showing size of lot, loc. tion of system in relation to wells, buildings,•etc. must be placed on reverse side.) l.a NEW INSTALLATION: (No septic t1nk or seepage pit permitted if public sewer.is available within 240 feet,) PACKAGE TREATMENT r-- SEPTIC!TANK Capacity - i_ T -------------------- ,. .------------------------------------------------ Liquid Depth ----------------- -------- [ ] • Size----------------- ] a P Y ----�--�--;--------'• YPe ------------- -- --- Material----------------- ---- No. Compartments ................. �C Distance tot neprest: -Well --------------------`--- p, . i -------- -• ----------- •----- + 1 Foundation ----'=""--Total Length Lme-""----•-"-"--- LEACHING LINE [ ] No. of Line� ,-------------------- Length of each line--------.--------------- --- g -------- D' Box ,-. Type Filter Material ____________________Depth Filter Material _______________________________ ------------ oundai ion : Distance to'nearest: WeH ------------ ----------- '------------- Property Line. SEEPAGE PIT { ] Depth__ ________ __________ Diameter y---------._.___I Number ------- ._.________ Rock Filled Yes ❑ No ❑ Water Table Rock Size . ----- -_-• - a �... ------------�=---------------------------••----i� o Distance to na est: Well ------------•------------- -------------Foundation -------------------- Prop. Line --- ----_------------ ` k REPAIR/ADDITION.(P'r;ev. Sanitation Pefmit# _..---••------------------ Date .------::---i_._______________-•_-} Septic Tank (Specify Requirements) ; _--------- Vii./ -------------------•-------------------------•------------------z-----------•----•----------- bis osal Field (Specify Re uiremer ts. r, ''®_/�j�� ' a ftT xS��9 , � 0� �•� .__ � ?_.. 7" - ---- -SP� ---- x' --------•- Q--- 4 X14� --------3 '------------- . (Draw existing and required addition on reverse side)' I hereby certify that I have preparedthi's 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 folio v ink: } "I certify that in Yke performance of 1l a 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 - --- -------•----- r BY ----�-- -2 - - r-- -,/�--�: .. --'---- _�.---� --------------•---------- ---.. Title ----- ( f other than own + t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ------------------------------------------------------------- --- ------- DATE ------ BUILDINGPERMIT ISSUED ----"- ---------------- -•------------------ --------------- -----------DATE ------------------------------------------- ADDITIONAL COMMENTS A t --- A-------- - ------ ------------------- ------------------------------- ---------- ------------------------- - --- ' L-, --------- Final Ins ec r6. p � --- ---------------------------Date . _%_ - SAN JOAQUIN LOCAL HEALTH DISTRICT L LI