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FOR OFFICE USE: OR01,71 USE: N 1 PPLICATIOFOR SANITATION PERMIT ............................ .... Permit No.�.9..x.,3.1 (Complete in Triplicate)• ... ......................................................... Dote Issued.l/..a.2 �`r.1 /q ..................................... ................... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for o•permit to construct and install the work herein described This application is made in compliance with County Ordinance t4b, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIION.........T..3.LS..-......... .......... 7 c /.CENSUS TRACT . � , City .. �.3...G... ./..y...5.................... ..... ...� .....................Owner's Name.... .':.. .. '--. ........ :.........Phone... Address...... ...... ...... * ........... ..... .......:.- ... ...................... City... / C. . ...........---.........Zip ............................ ............. Contractor's Name... .................. Installation will serve: Residence ffi Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other..................... .................:...... Number of living units:....1..........Number of bedrooms �3.. Garbage Grinder............lot Size........... .� A ..................... Water Supply: Public System and name,. .... ................................... .............................. ..................:..-.................................Private 19 Character of soil to a depth of 3 feet; Sand ❑ . Silt❑ Clay ❑ Peat ❑ Sandy Loom ❑ Clay Loam ❑ Hardpan ❑ 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 side.) NEW INSTAL.ATION: (No, septic tank or seepage pit permitted if public sewer is available within 200 feet,) „C PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_�Z .-.,e c74L.kC.6........................Liquid Depth.. ../../.......W Ca pacity.�.4'fl......Type..�F.IAS�Moterial..........................No. Compartments.......�r.�_............... � V� Distance tonearest:_Well.....Ze..rT..............Foundation.,,/ . ......... .. Prop. Line...°70---.-- LEACHING LINE [ ] No. of Lines ....................:Length of each� ��ine..:.. 0 FT Total Length .. ��....f� .....5 'D' Box... ......Type Filter Material.l� Depth Filter Material.. ... lg...........................rT......... < Distance to nearest: Well...�l`Zs.�......_.Foundation.15-0.�. ....Property Line.../6:.....................�..._,}. SEEPAGE PIT ( ] Depth.......... .....Diameter....................Number................................ Rock Filled Yes ❑ No�1 WaterTable Depth............................... ......... ... ...........Rock Size.... ....................................... Distance to nearest: Well.!.........................................Foundation..........................Prop. Line........................... REPAIR/ADDITION (Prev. Sanitation Permit#.." ........................... I... ...............Date....................... .:.................... ) Septic Tank (Specify Requirements)...... ..._.......... . .................................................................................................................................... t DisposalField (Specify Requirements) ...... ..... .:.' . ................................_............................................................................................... .........................................................I............:............. ..............................................---........................... ........................................... ......................................................... .....................................................;.............................`_.............. .................................................... (Draw existing and required addition on reverse side) I 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 licensed agents signature certifies the following: 1 - "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 become subject too.. ork an's Co pensation laws of California." Signed.......� .........................::....... .Owner By............................... .............................................'.......................... Title........................................:. ............................... (If other than owner) pOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..'._..... .1..................................DAT - 7: J ..... __. ..... DIVISIONOF LAND NUMBER.............. .:. ...................:.......:.-..; ..... :...:-............::....................:.....DATE........._...................>. .............. . ADDITIONAL COMMENjS..................:.: ..................:......' ' ...............:........_._........................................................... .......... .. ... ............................ ..........:............................. ......................................................................................................................... ...... .. ... .... ......................................................... ...:...................................................................................................................................... ............. ................ ...................................... .... ..... .... �..�...t .. ...... .... . Final Inspection by:......................... ... . 1..'. ..... ........ ...............................................DateS`..:.�7.7�2' . _..... - EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT /--Fzs 221677 aev. 2/26 3.77 75,