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FOR OFFICE USE: PPLICATION FOR SANITATION PF IT p Q - (Complete in Triplicate) Permit NOJ�.:.c..l...9./.... - __.....-... This Permit Expires 1 Year From Date issued Date Issued/Q---2_..2/! Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, Thi$ application is made in Rom It nce • Cou Or ingot an exi ing Rules and Regulations: R.crt, �y/ � y JOB ADDRESS/LOC AT N LI .. . . . .. ... .... _ ...CENSUS TRACT ................. Q 2 Owner's Name ...R�yG' til -- - 9 ...............................-- Phone 1..777;- S �n Q ... Address V.3........ �� / ... .. ... ------........................Ci Contractor's Name ._........... . .�... Xle?/.......................License #';QSy �3y.--. Phone .............................. Installation will serve: Residence ❑Apartment House Q Commercial ❑Trailer Court ❑ O Motel ❑OtherSZ/��L4yfcd- \ 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❑ Silt❑ Clay ❑ Peat❑ Sandy Loam X Clay Loom'K 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 INSTAATIONMt (No septic gtt�k HLor,1"page pit permitted if public sewer is available within 200 feet,) 41 PACKAGE TREATMENT I � SEPTI ......................... Liquid Depth ......�ct............. _ a_a �i oq�Capacity fTYPa ... Material.- ... No. :Compartments ... ...... Distance to Ineorel2 e�l .........t............_----........Foundation -----I.0-'*..... Prop. Line .......... 1 LEACHING LINE �Q No. of Line{ .......11PT-- ---Length of�eocnh line..._.rl2T'.�.. _.-. Total Length _30V.....-....._. `D' Box ._...✓.... T ilterAiraterial .K.�t�.........Depth Filter Material .:.::..�f�.............................. Distance to nearest: Well ..................... Foundatio -.:.Z.O.I Property Line ... �t........... SEEPAGE PIT ( J Depth ------._.---------- iQlameter. ................ Number .. .. ........................ Rock Filled Yes ❑ No Q Water Table Depth -----•---...-............................._..Rock Size ............................... Distance to nearest: Well ........................... .....Foundation .................... Prop. Line .............---. REPAIR/ADDITION(Prev. Sanitation Permit 511 ................................... Date ..............................._1 Septic Tank (Specify Requirements) ................... ......--------------------------------------------------------.--.----- -------------•- ........ ......----- Disposal Field (Specify Requirements) ---------------n. r : ....................... _.._.............---...--------..............-......_.-....._._..................._.--_.........._................................................._._..................... ............... (Draw existing 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 Compensation laws of California." Signed ..... :♦ - Owner ` ,� By ..-.. .�. Title �'1 ! ..... .... _............_..._....._ (If of than owner) Ub FOR DEPARTMENT USE ONLY APPLICATION ACCEPTE BY :... .... . DATE ....10-.�.-�.`_ .._.-............ --------------_- ------------ - --------- ------------.............. BUILDING PERMIT ISSUED .... ... ....................................... ....................... ..............................DATE ........... ADDITIONAL COMMENTS ..... ....... ....... ... ....----- ....-.-..............-....•----.-.---............................ ......-----------. .................................. ...... ------`— t � � G ` VA\ Jq".. , ... . ................... ---- -- Final Inspection by: . . - - .......................... .......Date .......Y b :3�. .� ........-... SAN JOAQUIN LOCAL HEALTH DISTRICT