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,A FOR"OFF.ICE USE — A . �.ON FOR SANIT6T109 PERMIT /�---�. p _.. _--- --- Permit No: _Yl7a (Complete in Triplicate) ,„ ,,,,,,,,, ,__- 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/LOCATIO ...V,?r0.._._ -_. �4 -_-- ...._.V._4 r>! ?.� 41- 40,dcfNSUS TRACT .... p Owner's Name -� .-. - - - ... .....----•------ -- -------------.Phone.36- �- Address _.-��rS.:-.>`............. / �lr---, ----------'-----------•---•--------•--' city Name ../.�rr'r.------------ .-- ---------_----- ------....License # ---- -- ----' _-- Phone ........ ..................... Installation will serve: Residence[]Apartment House❑ Commercial .[-]Trailer Court Motel ❑ Other --'- -------- ------------------ ----- j Number of living units:_........ Number of bedrooms .Y........Garbage Grinder ----- Lot Size Water Supply: Public System and name ........................-----------------------------.. _---'_-----•------------------ -Private Q� Character of soil to a depth of 3 feet: Sand 0- Silt❑ Clay ❑ Peat❑ Sandy Loam jKl Clay Loam ❑ 1 f Hord pan ❑ Adobe❑ Fill Material ____..._--If yes,type ------------------------ ---- N / /,- Imo. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT ( I SEPTICTANK% Size__�1� -..t!I ...��r--------------------- Liquid Depth ----__-.--------....... U Capacity L6.f"0..__.,--_ Type e;rK---/7-*r Material.?2!ti --------- No. Compartments 40x--- Distance to nearest: Well _J'_-----------------------Foundation ...P---.._____ Prop. Line .'YiQ.........._.... LEACHING LINE No. of Lines I................._. Length of each line---X19._-__------...._.- Total Length --------- '13' Box ...._ ..... Type Filler Material .A]A`.........Depth Filter MaterialJ-$�........................_-•------- Distance to nearest: Well _76_.............. Foundation - s --------------- Property line ...._.-------....------ . SEEPAGE PIT [ ] Depth -------_ ------__ Diameter ................ Number _.-__-----------_....... Rock Filled Yes ❑ No C Water Table Depth ...-------------------.................'........Rock Size ------- -------......-...----- Distance to nearest: Well�__�.....................................Foundation .................... Prop. Line ------------ N REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............._....-_...-.........) [ Septic Tank (Specify Requirements) ----------------------- ........------------ ---------------------------------•--•--`......................I-------- . [`\ Disposal Field (Specify Requirements) ------- ..................+-------------- ----------------- ----------- .......................... '- ....... -- --'-- ...... --....... --'---......— ... ......... ......... ....._...... ---•-- --- ------ ---- ------- ---------- -... - ------:... .......... (Draw existing and required addition on reverse side) —w I hereby certify that 1 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 Son 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 becomes uub'ect to Workman's Compensation laws of California.” o' Signed —E ......... ------ Owner Title .... -_ _.. - ...__ _...-. .- (If other than owner) •/ FOR DEPART NT USE ONLY APPLICATION ACCEPTED BY _-r��..C�Cll�N�s4 --- .................... DATE . ------------------------- BUILDING PERMIT ISSUED --- ------ . .....--- ....... .. -- --- ------DATE ------------ ---------- ---------- ADDITIONAL COMMENTS ---- --- _------------------------------- ... i. --- -------------_ -- - -- -----'_.--- --------- --- ..................... ........................ ....._.. ---- ... ... Inspection ...--------- . -- -- - � -------- - - - 1 Final by: .- - -' -----....Date .. ...... .... . .'- ... ..._ _..--- - ---------------------- SAN JOAQUIN. LOCAL HEALTH DISTRICT E. H. 9 1268 Rev. 5M