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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ll// Permit No. _7`f.:. 02 � (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/LOCATION ..................................CENSUS TRACT .......................... Owner's Name ............... .__... ............{.-.�..................Phone 1 ........7i6.Y... Address ...:..._...1-1.tp. ..... i 7 .. ................. City ......It Contractor's Name ................License # .dzPhone `�?.t�.� a./_.. Installation w111,1 serve:e: Res dencelopa.meet House-[] Commercial ❑Trailer Court ❑ c -.....� Motel ❑Other ............................................ Number of living units:.. ...... Number of bedrooms ....r�Garbage Grinder ............ Lot Size ._.../ �j�__, ........ Water Supply: Public System and name ........-------••-......... ......................................._------------ ........ ...............Private �JI - _ ____...._ H Sand❑--�+Sill E Clay Peat❑ Sandy loam r]—Clay loam ❑ Character of soil to a depth of 3 feet: p H bedpan ❑ Adobe ❑ Fill Material .._......... If yes,type .......................... . (Plot plan, showing size ��I t, (oca ion of system in relation to wells, buildings, etc, must be placed on reverse slde.) " NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT �SEPTICJANK Size............ .. _ (��`�y,s `tE � � ................................. Li quid Depth _-�.•-----•-•----•-•--•• Capacity,, .. . _Type -.------.__ ------- Material ............ ....... No. Compartments ...................... Distance to nearest: Well . .................................Foundation ...................... Prop. Line ...................... ( ],,,_J �;. "" s } Length of each line .. . ..._..._ Total length LEACHING LINE �No;�of'L�nes :1 #... . . ......_.. ............................ D' Box .._...�`TpeFilter Material .. Dept Filter Material ............................................ e t�will .... Foundation Property Line n Distance to near st:Weil ........... .. 5 PAGE P1T j lS�,y` „Depths s�! diameter ................ Number Rock Filled Yes ❑ No Q Water Table Depth ............................ :.......Rock 6ze ............ ---------- &stance to nearest: Well ...._.:____'" ----Founlation .......... Prop. line ...................... REPAIR/ADDITION(Pte Sanitation Permit # -------------------------------------------- Date . ..._...----..--....-------- ) I- /� _._,_ Septic Tank (Spgcify°kequirements)1 1 ... Q�CRr._ .. Tom .............•--- Disposal Field{{Spe fy Requirements} - ---------------------------•----------- ----------- I......_..........._.... -- ......-a#�+.: ... I -•........................ . ------------------- ......�--- -- hereby nd requ on se certify that I have re ared rth sea existing d!hatatheltiwork will rbesd n}e in accordance with---------------------- (Draw --- .. ._ ._ Y t? p pp th San-Joaquin County Ordinances, State Laws, and`Rules and Regulations of the�San Joaquin Local Health District. dome ownef`or;(icen- sed agents signature certifies the`foll wing: "I certify that in the performance of the work for which this permit is issued, I Thal)'nat`empler'any person In such mannef as to become subject to Workman's Compensation laws of California." Signed .. .... _ .. ... ..� ... ......................... ------ Owner < A B I.. -- ----- ��crw--- Y •--- --- -. ....- . .....-------...................... -• Title .... . i►..- - -...- - .... ( of r han owner) # FOR DEPARTMENT USE ONLY } ` APPLICATION ACCEPTEDi BY ..... - . .. ..... ....................... ................t. DATE _ . • - • - ..... .. BUILDING PERMIT ISSUED ._ ........ ....-- - - •................................ .•----.. .. ......I..DATE _ . ..... ._........_..... ....... ADDITIONAL COMMNTf .... .`.,"_`. `...... ._ _ _ . ... ._...... _.... ........................................ < �� ............... .._._._.._-___ .... ............ ..q`tiF................................................. ..._....--•......................... ................ ...... FinalInspection by: -•------ -----------------------------•--•. ------------...---..................................---Date ..... .. .. SAN JOAQUIN LOCAL HEALTH .DISTRICT �