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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT yy (Complete in Triplicate) Permit No. 7..- rl �� This Permit Expires 1 Year From Date Issued Date Issued ./0.- �. licotion is hereby mode to the San Joaquin local Health District for a permit to construct and install the work herein v..fcribed, This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ./.. 16Qo.... o .. .. �ii�� .. a54JS TRACT ......... .......... Owner's Name Qom•,'"'..... ... . . / ......................................Phone ....,�.?3:1..�t�4II...... Address J -b� s'a'... /'!T:. City . ..._. ,... . . .4................................................ Contractor's Nome ....... . . .. ... ... .......................License ... Phone .............................. Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court 0 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 Cloy Loam Hardpan ❑ Adobe ❑ Fill Material __... ----- 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 j j Size__.. ..................................... ... Liquid Depth .......................... Capacity ...._.............. Type .................... Mater Jol........ .........-.. No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. line ...................... LEACHING LINE ( ) No. of Lines ...................... length of each line __.......................... Total length 'D• Box . ... .. Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property line ........................ SEEPAGE PIT I Depth .. . Diameter ................ Number .........._._..... ......... Rock Filled Yes ❑ No ❑ Water Table Depth .......................................,........Rock Size ................................ y Distance to nearest: Well .................Foundation .. Prop. line . REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ........................ .......,.1 Septic Tank (Specify Requirements) .........................�... ..... .... n._....D. .. .-..............f....... .. ...w..........`3 -..-•-------- Disposal Field (Specify Requirements) .... ..� . • K4�.•--d---•. 'DKK. - - ............................................................................................................................................................................... .............. ......................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, Mote laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Won- sed agents signature certifies the following: "I 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 Workman's Compensation laws of Califomio." Signed Owner 8y .. _... ' .... .......... . Title •,......... .__............-- --- --..... (If 4of er t owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... ... ....................... DATE /..Q'!7.99 .2..7----------- BUILDING PERMIT ISSUED ............................................................................. ...DATE 11T{ONAL COMMENTS ......................... ._....._........................ .. _ -----------------------------•----••---..................................................................---------.............................I............. ....................................... .. . Final Inspection by: ...............11r'....�._J ...............................----•--•---......................Date .. . �.. SAN JOAQUIN LOCAL HEALTH DISTRICT r - 1 7179 1 M