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FOR OFFICE USE: .. APPLICATION FOR SANITATION PER"IfT - - - _-•- � (Complete in Triplicate) Permit No. Date Issued -Zl-./--.1j� ----------_----------------_----------------------___ 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: JOB ADDRESS/LOCATION � . / 5 7 ----1`. oz.�`"`"r�'' �#1SUS TRACT -----------------•---- Owner's Name ------/l! •-------------- �f ------------------------------------•----------- Phone Address ------- -- i6. �� -/C- - City tj., `-�G� G?�-- --- 1 `•---•-- Contractor's Name - y ----/ License # - -{�.rf'� Phone . Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ,❑ Motel ❑Other ------------_------------- --------------- � Number of living units:__/-___ Number of bedrooms ..-,2----Garba e Grinder�C�_-- Lot Size Water Supply: Public System and name ...- z.+wt—__-__.--_rf..� - __________________ -- ----------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ;,T SEPTIC TANK" �Siize-_(�`�__��_x_�--------------- Liquid Depth _-_S_--____-----._-___._ � Capacity Id_ 676MTypeplj &60-0r//Material---e�.c�----n-/KNo. Compartments -,:2................ co Distance to nearest: Well - -S-0- -------------------- _1a-------------- Prop. Line ---- ----_ -__-__ LEACHING LINE J` No. of Lines ------------------ Length of each line---- --------- Total Length __ . _ 'D' Box ----- Type Filter Material 0-16*T1-------Depth Filter Material __ __________________________________ .._._..._ Foundation � \ Distance to nearest: Well ._�`d_-_ -..- __ ------------- Property Line _._ _.__/---------- SEEPAGE PIT Depth --------- Diameter Number ----- ----------------- Rock Filled Yes No C1 Water Table Depth l ------_----------------------- Size ---''`'�___ ---- --------•-------- Distance to nearest: Well ----------------Foundation ------- Prop. Line ___ __---_--__-_ REPAIR/ADDITION(Prev. Sanitation Permit=# ______________________________---------_.... Date ___-___---____-----__--____-______) 1 SepticTank (Specify Requirements) ---------------------------------- --------------------------------------------------------------------------------------- , Disposal Field (Specify Requirements) ---------------------••----- ----------------------------------------------------------------------- ----------------------- -------- ---------------------- -------------------------------------------- ----------------- ---------------------•------------- --------------------------------------------------=------------------------ ----------------------------------- ------------------- ----------------------------------------------------- --•-------------------------------------------------------------------- -------- (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------ - ----------------------- ------ -------------- Owner BYTitle ---- -M---------------------------- (If other than owner) FOR D PARTMENT USE 2NLY APPLICATION ACCEPTED BY ------- - --- --- --- ------ -------------------------------. DATE --- •----7-------- BUILDING PERMIT ISSUED ---------------------------------------------------- -------------- -------------- --------------DATE ---------------- ----------- ----------•--- ADDITIONALCOMMENTS -------------------------•------ ----•-•-------------- --------------_-- ................... -_----------------- ------------------- ---------------------- -----------------------------------------------------------------------------------•-------•---------------- ------•-------------------- --------------------------------------- --------------------- --------------------------------------------------------- ----- -- ------------------------------------ ---------------------•-------------------------- a - ---- ---- - -- -- Final Inspection bY ---------------�- -------- - ----- -- ------------- ------ - -- - ------------------ Date �.� ----/� SAN JOAQUIN LOCAL HEALTH DISTRICT 61