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FOR OFFICE USE. ---••---w---.- " APPLIC •_ __ � SANITATION PERMIT .......... ...•-� - - ---�...-- -.... . 1Complete In Trlplicatel „ Permit No, ...... -•-••--•...........................I.._-_.... This Permit Expires 1 Year From Date Issued Date Issued .s ......... Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance Jwith C unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ��.................z fes/ „CENSUS TRACT .. Owner's Name ..... •.......................... Phone ............. Address /iGa p?0 ...... ... ... . ...... ... . 4.I. ................................ City . . ..... .........-•----•---- y Contractor's Name ....... . .` -•- �-�-.. LicenseQ?.�L.� _ Phone ..9 K—,24/4 Installation will serve: Residence 031�partment House I-] 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 b Silt❑ Clay ❑ feat❑ Sandy Loom 0 Clay Loom ❑ Hardpan J' 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 aide.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK D< Size. I-._ x.,.. - C �. ......... - Liquid Depth ...y. ................. Capacity �. U___-- Type 6,4___`- - -f.. Material. :...._ No. Compartments ...................... Distance to nearest: WeU .._ ._... ?` ................Founda#iond.....------.... prop. Line _5`? .r_ . LEACHING LINE ['i-' No. of Lines _... -------------- Length of each line..�0-�lz�Q--yU.r. Total Length ..... .......... N 'D' Box ._-i'I Type Filter Material J M? -Depth Filter Material . ........................... Distance to nearest: Well ., -�..t------- Foundation .._/o............. Property Line .JI.......... SEEPAGE PIT [q," Depth .a.�- -___.._-- Diameter _....__ Number ---------_7 Rock Filled Yes� No 0 01 Water Table Depth ....JO-Q....... - - -------------------Rock Size ........ Distance to nearest: Well ---.146..........................Foundation ...s"i.z__....... Prop, Line 5.... ........-.- REPAIR/ADDITION(Prev. Sanitation�Permit# -•__-------------=------•------------------- pate .................................. } Septic Tank (Specify Requirements) ............................................ -------------- -------------••------ ......... Disposal Field (Specify Requirements) _____________ _ _ ----------------------- -----------------.._..-----------------------.......-•---•-------•----•--•--•--------------------•--........---•--••-••......••--••_.... {Draw existing and required addition on reverse side) 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 Rules and Regulations of the San Joaquin Local Wealth,Dlstrict. 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 g subject�f7oWork an's Compensation laws of California," Sisnod to �C/7 �?._ '_. 3 Owner -------- BY .-•---------_-------_ -Title .... �d��------------- - - (If other than owned i R IYEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- - -..----- -- --------------- DATE - . ------------------- BUILDING PERMIT ISSUE© --- ------.DATE ....-.. -- ----- AD€71TiONAI COMMENTS .................................... .................... . ------- ------- --------- ------• •-- ------- -----•---- ------------•----- ............... - ----------- ----------------------- ....... ... _.. ------ �- - .ZS - - -- --- - ...... ........ ---------- Final Inspection by: .... -....- ---- _._._.-..-- _.. Date ..... ... ..... 13 2 -6 v' SAN JOAQUIN CAL HEALT� DISTRICT 8/7h 3M