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T FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT (Com` in Triplicate) Permit No. .7.. ....................:....................•--- ..........................................�......�... This Permit Expires 1 Year From Date issued Date Issued Application is hereby mocle4o the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application is.mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: u JOB ADDRESS/LOCATION, . 7 _. -,� G�..� CENSUSTRACT I ....................... .. Owner's Nome --- ............ ........... .. Address4/, o. Phone . 7 . , .... ........... i � r. Gty�.; ........ ...... Contractor's Name ..........._•- _--- --- --•- --------License # one IQ 7 •• = .. `Ph Installation will serve: Residence,'Apartment House 0 Commercial oTrailer Court 0 Mote! Other = _ ............ Number of living units:...... Number of bedrooms'} .. .Garbs Garbage rider •-----...... Lot Size ... Water Supply: Public System and name .............. ............ .g �'' I ��...... .......... . ...............i:..:......................:.::. ..........Private Character of soli to a depth of 3 feet: Sand'0 Silt Clay I r Q y ❑ Peat❑ "'Sandy Laarri fl�XClay Loam (] . Hardpan j] Adobe Fill Material ,, ..---....... 1003,-typo ............................ � ' Mot plan, .showing size of lot, location of system in relcltion to wells, buildings, etc.rrmust, 'be placed on reverse side,} NEW INSTALLATION:,,.,,,(No,septic,ton k.or seepage pit permitted if public sewer is avoilab a within 200 feet') �^ PACKAGE TREATMENTfl.] SEPTIC TANK � (J S- e. ---15...1 .-_.. ...-•--- ' . Liquid Depth .....�r... - - ' Capacity . Type . ._ Material :. No. Compartments ........... J t_. Dis once to nearest: Well .............tea- '1' ..Founds#ion �/U...-•---... Prop. Line �*'...� ..... N LEACHING LINE A No. of Lines ...__..f ------ Length of each line.......f�}..�......... Total Length _.l .�.......,..., `D' Bax ,Type 'filter Material ...._Depth Filter Material is,..... Distance to nearest Well Foundation ...l.O..��..�.._ Property Line _�.�fi:....... . „►}, • ................ . .. . SEEPAGE PIT SCJ, Depth .--,;� ....I*L.:_ gnieter �.y'...._ Number .__. 1-- l . Rock Filled Yes No � �V►�� R Water Table Depth; .#.. :"9 p ' � .�I .�.sit.... :..........:: Rock;Srze _ .. � r f Distance to nearest: Well.:x./..6 9..---......:�:........ Foundatiorf,: 010-Jt ..-. Prop. Line ..-5 ........ I J REPAIR/ADDITION(Frau. Sanitation Per ............. ..................... Date r Septic Tank (5fy eci "Re uire ! P q -rvnts- -I ........ - • Disposal Field (Specify Requirements) -----•-------------------------------=---------•.._.--:---- .-_y--------------------- - � - •..__......:.........._.......__...................�............................................................................................. - L% FAQ (Draw existing and required addition on reverse side) i �164: 1 hereby certify that-1 have prepared this application and that the work will be done In accordance th Son Joaquin County Ordinances,.StdtekLaws„ antl,Rules,-and.Regulations of-the Sane Joaquin�Local•Health District. me owner or licen- sed agents signature certifies the following: -r "I certify that in the performance of the work for which jhis permit is issued, l shall not employ any parson in such manner as to become subject to Workman's Compe ationli�w of California.” • `' w i Signed .....................•----- --- Owner 8y ...........�i -----..----- Title _.... s r -- ----••-- - p of an owner) FOPDEPARTMENT USE ONLY APPLICATION ACCEPTED BY .......... � .- ._..__: .. ........................ DATE ...1 . ..11 .).`.......... BUILDING PERMIT ISSUED ._... :.... .. .... . ... ... • ...... .__ . __._ ...-... DATE ..........__...............I.......---••-. ADDITIONAL COMMENTS .... �/- � .................................•------.. .-------------.... ,Q... .......__.....__.._.... ............ .................. ................. -'-•------ .. :.. ..... ............•-•-..._.__... ------ ................... Final Inspection b , :.. ................ .. t ..:.................................................Date fyf� . ............ SAN JOAQUIN LOCAL HEALTH DISTRICT ' i t=K-13 241--jam— ray 90-0 ---