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Wt'li.CA f I0N F oj? SANIYATION PF -MT ...............................---............... .... %.S..r1.a.c� (Complete In Triplicato) Permit No. ....... This Permit Expires i Year From Date Issued Date Issued ..S �l:�S 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, .LOB ADDRESS/L ATION .��.� ...U.__.1�C �....._ ...,_,o, ��X ..... ................CENSUS TRACT Owner's Name .. ....._. !'`7..........................—c' ,.. Phone .................................... Address ............................................ City ' ------------------ Contractor's Name .............. . !�� _.�.i_ �`� c .........License #/.��.?'. ----- Phone .............................. Installation will serve, Residence❑Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other . .... 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 EJ/' Ciay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materlal ------------ 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 SEPTIC TANK ------- Liquid Depth ........................ ( l � ) Size........................................ Capacity --_. .. .. .. Type ____............... Material.-, ----- No. Compartments ............... Distance to nearest: Well ... ................................Foundation ...................... Prop. line ............... LEACHING LINE No. of lines - --------------- ------ length of each line.......__._._._.-.__...--.. Total Length ..........................9 'D' Box .- Type Filter Material ....................Depth Filter Material ...........................................iE Distance to nearest: Well ........... ............ Foundallon Property Line ........................ SEEPAGE PIT ( j Depth [diameter ................ Number Rock Filled Yes ❑ No Water Table Depth - -----------------•----• ---------Rock Size ................................ .) Distance to nearest: Well ------------------ ----._Foundation .................... Prop. line --_-------------6;9 REPAIR/ADDITION(Prov. Sanitation Permit,# -------------------------------------------- Date .................................. Septic Tank (Specify Requirements) -----.....-•-•-•----••-•............... ............................... Disposal Fiela (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 f 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 (If other than owner) ` ------ -- Title _ ...-�, ```: ...c...... . .. .... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ' ............... •---..........................._....._.._•..._. DATE .....:. .:' !.l ...7.. ... BUILDING PERMIT ISSUED ......... ..... _ . DATE . . ..................................... ................................•--...... . ..................................... ADDITIONAL COMMENTS ................... .... ................... ............................................................................................... ...._._. ...................... .......................... .. ...•----••--•-- ... .._ .......... .......... . .............. ....... y' .............................. ...-•... ...... _. ...- .... . Final Inspection by: ................. .......... Date ... .. /. .. ��. ............ .._. :.................. Ell 13 2L 1-6 11,Cv• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M