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r FOR OFFICE USE: APPLICATION FOIA SANITATION PERMIT ...... 777 �7 " - {Complete In Triplicate) Permit No. ..................... i.........:.......... .........__: ...... Date 1aa r ..... This Permit Expires ? Year From Date Issued ued ..L." :.77, 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. 519 and existing Rules and Re ulations: A JOB ADDRESS/LOC N ..��. .C.. ..... f� �...... ..........CENSUS TRACT Owner's Name ... ....................Phone Address .. .. /l ..__.... .._ .. ........... City . , Contractor's Name ./ LC,.. .... -_---- license ylt y " ..... .. ......... ........ ............ .. Phone Installation will serve: I Residence p Apartment Hou' sefl Commercial ❑Tra€ler Court p _ Motel []Other ..7.me: ..... c � 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 Silt❑ Cl' a_y-0 .Pea_t 0_. Son y Loam_0. :Clay,toam —. =-=-•-Hardpan 0 Adobe 0—Flll Ma rial ............ If yes,. pe............... . (Plot plan; showing size of lot, location of system inirelationzto wells, buildings, etc. must be placed on reverse side.) � NEW INSTALLATION- (No septic tank or seepage pit permuted if-public sewer is available within 200 feet,) PACKAGE TREATMENT r •� I l SEPTIC TANK . Size--a D .......................... Liquid Depth .a7�z'� 'Capacity _#.��_ . Type tee. _.�Materia!"�_... No. Compartments _Z.............. ' Distance.to nearest: Well .QQ Foundation .... ... .. ......... Prop. Line ..... .w?_.:.. LEACHING LINEK No. of Lines ...................... Length of each line----ZVA........ Total Length ......40.0 ` 'D' Box ...... Type Filter Material . .------ Depth Filter Material ......lcP............................... ® �z pistance to nearest: Well .. �--..._....:. Foundation ...... .... .... ....... 'Property Line ......�_,�.`..... � r r SEEPAGE PIT � Depth ".sw).....:.......... Diameter �..IC_C,�_ Number ................... . Rock Filled Yes " No � .` Water _.�.. ....� ater Table Depth ...----�_..�.-`f-------..............Rock Size . � � Distance to nearest:'Well .1. d ................................Foundation ........�:a..r Prop. Line .... REPAIR/ADDITION.(Prev. Sanitation Permit# ............................................ Date .................................... = -- Septic Tonle{Specify Requirements) ...... ........................... Disposal Field (Specify Requirements) ..................... ...... ------ ------------------------------ ------------- -------------- -------------- - ---4 --------- •---- (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 Health:District. Home owner or licen- sed agentc signature certifies the following: a "I certify that in the p rformance of the work for which this permit Is issued, 1 shall not employ any person in such manner- w" as to bec a subject o Workman's Comp nsation.I wq s of California. Signed _. . OwnerBy .... --------- J'itle _.. _" d (if other thd owner) FOR DMRTMF.NT USE OM APPLICATION ACCEPTED BY._ : -- -- - ---- DATE7 BUILNG PERMIT ISSUED ... ------------ •• -----••- _ - a: i-- -- - ---- ----------DATE ...._.... ...ADDITIONAL _. COMMENTS -------•--•-------- •........................... ....... ........................................... _._.:. -------------- _--------._..-..--•-----•••--- Final Inspection by: ------- EH _.. -- •-•- .....Date .. ....L. / ... 21 1-6 �• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h Spy