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FOR OFFICE USE: £� APPLICATI[ON FOR SANITATION PERMIT " Permit No. ..................... (Complete in Triplicate) _______________________ This Permit Expires I 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 Ordin a No. 549 and existing Rules and Regulations: J08 ADDRESS LO N .. .fT_ - ..' .. `° ................... ..CENSUS TRACT ..... ... Owner's Name _ ....... .......................... •--•-• ....Phone . 4��_':.Q.... 7. Address --. .... 40--------•---------------- --. City ...... _. Contractor's Name 51C.LF7............................. ............License # ------------------------ Phone .........................:.... Installation will serve: Residence ❑Apartment House Commercial ❑Trailer Court 0 = Motel ❑Other Number of living units:___!_-.__ Number of bedrooms ._T.._._.Ga bage Grinder .. '?.. Lot Size ....... .................................... I F - /- Water Supply: Public System and name ..._..__:: d lA: _.:.:Y'.. _C" :....Cus....................................................Private ❑ Character of soil to a depth of 3 feet. Sand 0 Silt O'» Clay•❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpdn'Q--_Adobe Fill Material ............ If yes, type ............................ {Plot plan, showing size 6f"lot, location Of system in relation to wells, buildings, etc. must be placed on reverse.side.) NEW INSTALLATION: (No septic _t 11 or seepage .pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I r SEPTIC TANK.1 Size-------------------------------------•.--------- Liquid Depth ......_............. :,...__ 7 f Capacity ...................-Typq_ ..... Material...................... No. Compartments ................ Distance to nearest: Well `............................... ....Foundation ....... Prop. Line .-•-•-_-- - � LEACHING LINE No. of Lines -:_._.....�:_:~__.._. Length of each line._._._::Z.[�_=_.! '_ Total Length..... .....-. 'D' Box .... ._.._ Type Filter Material ....t_Prh_....Depth'Filter Material .- ... .lf!c ........::... Distance to nearest: Well ._/Vi'!e....__._ Foundation ..._-_ _._._ ...... Property Line .,�....5..- ... �� SEEPAGE PIT Depth .:- ' �______ Diameter 3.._...... Number ........cZ.............. Rock Filled Yes No Q Water Table Depth .............Rock Size ...::........_ -------•---._....-•---•-•--------.. .................. Distance to'nearest: Well .../VA-?7.e. Found cors lohoc.... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# 1 / f9 ®J� yl� ._ � x: - t, Z i/ a } f. Date �.:_ 6 0 Septic Tank (Specify Requirements) ......................... --- ............ -........ ----•----. .................... ...... -•---- Disposal Field (Specify Requirements) ...................<fr!? ----__-- -___ ........... �l- --- - --------= ..................... ------------ -- . . . .. . _5- --- . -------_-.. _ - ! (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 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: ` . "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 Deco sub)ect o cm 's Compensation Iaws'of.California." r ' Signed --= - -------=------------- }..`::.. Owner I b ....ay ----------- ................ �T itle...... ------......_. _ _. .................. ------ -------------- (If other than owner) 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .. .. ........ - DATE .. ... . .. ........ BUILDING PERMIT ISSUED ---------- --- -•_-- �_ Epi •DATE:-.-_------ - ADDITIONAL COMMENTS f� .. ----•- -------------- -•--•-..... -•---•••----...---•-•---•-•••.... ................. ....•-•--............... ....•.. .;_ ---•---......._...._. .............................. ..................................................................._•___...._•....................................•. ......:............................. .. ... .......... ...................................................................................... ........... Final Inspection by. .__.'._....-- ate �; :. �_ D SAN JOAQUIN -LOCAL HEALTH DISTRICT '" F G H 13 24 i-,An D.- se,s 7/79 3