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FOR Qf FILE USE. APPLICA.TIOW-FOR SANITATION PERMIT S R lComplete in TrlpllcatoY =i''' Permit No. . :..`f---•--. r date Issued This Permit Expires 1 Year from Date Issued Application is hereby mode to the San .Joaquin Local Health District for a permit to construd and install the work herein described. This application is made in compliance with Cou Ordinance No. 549 and existing Rules and Regulations. f r JOB ADDRESS/LOCA TION ....................................CENSUS TRACT .............. Owner's Name ...---- . . ----• ✓. .....I..............I.-..................................Phone .................................... < .--... Address .--..-. ---------- .. City ..... . ....-- _... Contractor's Name :_ G .......- ._......License �` /..,,�. ..l� ,r Phone ............. d ... .. . .... r Installation will serve: Residence p Apartment House Commercial OTraller Court 0 Motel 0 Other Number of living units:---/....-- Number oAbrooms .. .......Garbo a Grinder Lot Size g --••- .. ................... ,�Water Supply: Public System and name .. ...... ---" -----•--.........................................................Private [} Character of soil to a depth of 3 feet: Sand 0 Silt E] Clay ❑ Peat❑ Sandy Loom ❑ Clay Loamy Hardpan [] Adobe 0 Fill Mpterlal ............ if yes type............... .........I. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) F NEW , (No septic tank or seepage pit permitted if public sewer:is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TAMC f l Size... . .. ------------- Liquid Dept . Capacity -i�.- .. Type aterial.. . .. .. • No. Compartments ... .. S Distance.to nearest: Well Foundation ---/10 Prop. Line .. LEACHING LINE [ j No. of Lines ....- ------- Length of each line--- ----------------- Total Length .-�. ............ Box ............ Type Filter Material ....................Depth .Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line ........................� SEEPAGE PIT [ } Depth !- ./B Diameter �!'.' Number .........4A.............. Rock Filled Yes, ' No I� -.--- Water Table Depth Rock Size ------ Distance to nearest: Well { ?` ...Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................... f Septic Tank (Specify Requirements) ....................... ....................-....................:............ ----......_-----••...- ............... Disposal field (Specify Requirements) --------•-----------. .......................................................... --------------- ----------------- ----- .----.---------------•---------------- ...-------------_ 4 --------------------------------------------••---•---------------------- --------._...-.-•--•---•-------...-------•-------------.........-----------------.. . .._............... (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: "1 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 arkman's Campe satian .laws of California." SignedT Owner - �L��----------- By ---------------------------------------------- -------- ---------------• --•--------------------- jitle _..---...... --------------- . if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- f•� - DATE .L,,jil. .7Z... ... ..:....... BUILDING PERMIT ISSUED ----- -------•---- DATE ......................................"..._. ADDITIONAL COMMENTS .. --- - --•- --'�- � :L7- �.. .._.... . .__ . __ _. Ina Inspection by: .. . . Dale .. ......-. _ - -. V. � SAN lOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M