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FOR OFFI �SE: APPLICATION FOR SANITATION PL_. iIT /* (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued 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 .-- ---Z_7_��_ Syr_.._._ i_12�C/�I-=S------- -s.---------- ----- - -- -- ----. - � - - -- - --- -- - -------- CENSUS TRACT _---------------------- Owner's Name -�- > -------- - K171 S '��S -- �`j5 C� ----- Phone --- ---------------------- Address --------- - - Address -- 6 0 ------------- Ro,Q�_ T --------------------------------- - City -- --------------------------------------•-- Contractor's Name -�/� _ ___ . ��%C � —r�'.---- --------------- .-.License Phone Installation will serve: Residence [� partment House❑ Commercial ❑Trailer Court i❑ jMotel ❑ Other -------------------------------------------- Number --------------- ---------------------------Number of living units:--- Number of bedrooms _.-----Garbage Grinder Lot Size ___--__. .. Water Supply: Public System and name ------- ------------------------ ----------- --------- --------------------------------------------Private FZ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy Loam W-- Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materia! _ 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 [ I SEPTIC TANK [.4--• Size-_`f f`� S.`l_ ____________ Liquid Depth ................. Capacity _1�24W____ Type Material Material N� � -No. Compartments _oS_________________ Distance to nearest: Well _____ _ ______-______-Foundation --IV------ Prop. Line -S__-_.________ LEACHING LINE [t�-- No. of Lines g ,7 r g r c ___..__-_._____ Length of each line_.__ _.,� _ __._ Total Len th __.�.3___l�________._. 'D' Box y471.. Type Filter. Material _, 44lC___Depth Filter Material _ /_X_..._-_-_._____-__________-_-. Distance to nearest: Well __ ------------ Foundation -------- Property Line ------___________ SEEPAGE PIT [ ] Depth __ .._ Diameter Number _ _ Rock Filled Yes ❑ No '❑ Water Table Depth ---- - --- --------------------------------Rock Size --------- --------- -- Distance to nearest: Well _____ ___________________Foundation ----- - Prop. Line .____--______-_-____ REPAIR/ADDITION (Prev. Sanitation Permit# ----- -------- Date __----------------.---------------) Septic Tank (Specify Requirements) ------- - ------- --- --- - --- Disposal Field (Specify Requirements) --------------------- ---------- - --- - - -- - ------------------------------------- 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. Hoene 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 beco e�Sj.eclto Workman's Compensation laws of California." Signe - -------------- By - ------------ - - - - Owner -------------------------------------------- -------------------------- - Title - .. - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B }--••------- ---------- - ------------- ------------ DATE 1_- BUILDINGPERMIT ISSUED --- -- ----------------- ----------------•--------------------------------- --------------------_----- DATE ----•-----------------•-----------•----•--- ADDITIONAL COMMENTS -----------------------------•------•-•-----•-•--------------------•--_____------------------------------•---------------•--•-------•=----------•---••---------- - o ------ r► a$ _. _. � z =-------- -- - --------��---- ------------=-----------------> ----------- ----- - _-------------- --- ---- -- - --- --- • yyDate teELrInspection by: -- w SAN JOAQUIN LOCAL HEALTH DISTRICT See- P�evev�i? Sc ,� lr�: �1�e.d ,�• !'tedq.Pry ow�e� ohm skifcd A Zkerd AAA ,007- the Guo ,_ �a oma., �� i�r�dr�rvra� /�h e for- +1te Dov f- -e�ncA t,7 &4?d Jizt Cor,f e4-