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FOR OFFICE USE: yK APPLICATION FOR SANITATION PERMIT 1,69 (Complete in Triplicate) Permit No. JY:SX6 ..........- ----`----- --------------------------- ' ----------------------------- ---------------_---.- 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 T✓ � CENSUS TRACT .................. Owner's Name ----- St"7.z/ ---------------------------------------------------- --------Phone _f- Address _. _... .A [ut ` ��TQQ------ -��- ----� - Y'�.�.------------------------- City - --- q�` - - Ole Contractor's Name ..--a V,4� ��-' x�__-----_--License #Z'SS4. 7 .. Phone ._'¢.��.L? Installation will serve: ResidenceX Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other- ----------- - Number of living units:.--/----- Number of bedrooms .3------ Grinder ----- Lot Size Water Supply: Public System and name -------------------------------- - ------ ---------------------------------------------Privatex Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam C] Hardpan ❑ AdobeX Fill Material ------------ If yes,type ----------..--------------- (Plot .............(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 tapk or seepage pit perm_ itte'd if public sewer is available within 200 feet,) .. PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size.----..__-----%_5..._---------------- Liquid Depth ......5�-oe...... Capacity J216.0 ----- Type P,,0446zTMaterial:4 No. Compartments ---P -----.----- Distance to nearest: Well _ ..... ---,1.O..._-------- Prop. line ----,�----.. - LEACHING LINE [ ] No. of Lines �---------__ Length of each line-.7S'".c.QS-.... Total Length _/�f2--_-----._... r f 0 'D' Box Type Filter Material Depth Filter Material -----/eP-"e.........I...-..�---.. 0 �. Distance to nearest• Well _../.Bf�_ *_____ Foundation ._GO._ __ .._. Property Line _.�--_._._.-_--._ SEEPAGE PIT ( l Depth .. �.__ Diameter Number ____7-- ------------- Rock Filled Yes &---Ko i❑ /, / Water Table Depth .._�S'.................... .:..... .Rock Size ..-:�.ia�_� Distance to nearest: Well ......LFO--.... _ ......_-Foundation Prop. Line ......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ...-..............................) C. r Septic Tank (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 r.. 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: "1 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 blect to Workman's Compensation laws of California." Signed ____ C2us tt.L.. Owner ------------- By --- -- -- ---------- --- ?------C_ __.-�---------- Title " (If other than owner) FOR DEP WMENT USE ONLY APPLICATION ACCEPTED BY _ :¢ - 1.............._..._...._._..-._-- DATE ._.__ L_ .7 ------- BUILDING PERMIT ISSUED ---------------. ------------------- -------------------DATE .---------.-----_--------------------- ADDITIONAL COMMENTS . _`_ _ -- __.._ - - ..................... _ - -- ------ - -- -------------------------- - - .... - - Final Inspection by: �: -- - -�------- -------- - --------------- ------- --- ---- - - -- `f .-- ' - Date Y,L� SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1.'AR PP,, 5M