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FOR OFFICE USE: AppLICAT�ON FOR SANITATION PERMIT ....-••........................................ Permit No. -- 3 0 (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 .....- _. ..1.475 .._%e_X�t leG _ G/...............................CENSUS TRACT ............-............ . Owner's Name - _ -_•= 01--------------- ..._............_,.....--------•--................-....Rhone .................................... Address ............... 1?- -----• - �/--------•.........City ...................................... .............................. I 4 lY jj Contractor's Name .............` "r License :.. ,t. Phone l� Installation will serve: t Residence A artment House Commercial _ � p fl ❑Trailer Court ❑ � Motel ❑Other---- ........................................ Number of living .......units: Number of-bedrooms .Garbage Grinder Lot Size ...`iJ"... z ....... Water Supply: Public System and name ------ ...-•.................._.------•--.....---..._-..............---..............._.................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam j Hardpan ❑ Adobe❑ Fill Material ............ If yes,type............... ......... (Plot pian, showing size of lot, location of system in relation to weds, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or seepage pit ;permitted If public sewer is available within 200 feet,) r << PACKAGE TREATMENT [ ] SEPTIC TA {C ] Size....C, .. ►� ..l,C�_______________ Liquid Depth •�....`_........_. ._..� Capacity_._/. Type -----J :_.._. Material No.No. Compartments r' � I Distance- to nearest: Well .......LOP-------------------Foundation --�--�--------•_ Prop. Line ...."ap........ LEACHING LINE No. of Lines �... g ... .Fj�...... Total Length ..�.. � ] ......... Length Len th of each line..---- -- ............... 'D' Box .. ------- Type Filter Material ..._.. _ ..Depth Filter Material ........f..Jr............................r Distance to nearest: Well ..../.eZ�...... Foundation Property line ........................4 SEEPAGE PIT p ---�:.�r. . Diameter -��1.__..__. Number ---.•---._... .. . _.�,,....,.. � ] Depth -•-- _ Rock Filled Yes No �❑ Water Tablot e Depth ------------------------------------------------Rock Size -------- p Distance-to nearest: Well Foundation _ Prop. Line ...................... REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. SepticTank (Specify Requirements)................................. ------ ----------•---•------••-••-- ..............--......................_................................. Disposal Field (Specify'.Requirements) ._.__.•.:... I r ..--.-I........................ --•--------•---•-----------------------------------------------------------.-------------------------_.--••--•-•--•...........-•---.._.•......._..-_...__....._...-•-•- .......................... (Draw existing and required addition on reverse side) E I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules 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'whirr this permit is Issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed --.•- ----- - --- -----------•----- -------------_-- Owner BY ----------- ------- Title ----_-------- ................... ....... ........................ if of er t a w'n r FOR O PARTMENT USE ONLY APPLICATION ACCEPTED BY _..--- DATE .._-_,- ' ............................. -------- - BUILDING PERMIT ISSUED ....- - _...__._.._.. DATE ADDITIONAL COMMENTS .._.._ f_�./_ -_..____' ------------ -------------- --------------------- / ��.7? �! --- -------•----...- ....---..__..._.......-----------•-•-•- _•• -------------.-_ ::� -------------------- •----- •-- -_---------- --------.._..._-..----- --------------- -----------------•------------__ ----------- --------------- -------•----------------------------------•........ - - -- -------- FinalInspection by: -------- ---- ---------------------------------.._._---_-._._.._.......---...._.._....Date .....-.7_./��r. ..,�..f.........---.. EH 13 21t '6v• SAN JOAQUIN LOCAL HEALTH DISTRICT / I71 3M