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„ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 75 Permit No. ..... ............. _ (Complete in Triplicate ' ........"...".....................". Date issued ....3.'•-�....'7.� .......... - This Permit Expires 1 Year From Date Issue .............. struct all the work al ealth rict for a Application is hereby made to made in Joaquin cwitih Cou©ytOrdinance No. 544 and existing Rulestand Regulations,rmit to con 0 described. This application is ma , - � � ............ ..."...C`E`NSUS TRACT --' ----.-.-.-.-.-.........._.,... JOB ADDRESS/LOCATION ................. C... — F --------------- City ........ Address ... ------ ------License #�� -.-- Phone Contractor's Name 1. l Installation will serve: Residence JgApartment House C] Commercial ❑trailer Court ❑ I � Motel ❑Others------- ----------------------- ------ Number of living units:.... .-. Number of b drooms ..�` .--Garbo e;Grinder of Size .1../._ .""........... ..........................Private C3Water Supply: Public System and name .- `" Character of soil to a depth of 3 feet: Sand❑ S ❑ Clay E] Peat E] Sandy Loam El Clay Loam ❑ Hardpan ElAdobe ' Fill Material ".-.......". If yes,type ......... - buildings, etc. must be placed on reverse side) {Plot plan, showing size of lot, location of system in relation to wells, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �r� 7--/ C� • . Liquid Depth ............ . i SEPTIC TANK 3 PACKAGE TREATMENT ( ] t ] Size................ .... ...........• ."".."._ - - CapacityNo: Compartments .............. -------vi .... ..... Type ".... ••- -..�-..." Material ----• "... ". Distance to nearest: Wel! .". .......... "Foundation ----- ---------------- Prop. Line ...... J LEACHING LINE No. of Lines Length of each line Total Length ... 7------- -- -�-- ,ter 'D' Box - Type Filter Material ��`G'� -•- Depth Filter Material YP De ....... -16 � _ ��pp 7,,_' �^l �9 Funclation . -._..r — Property line 1 Distance to nearest: Wel) ./�c�--.._..-..." -" o r (. Number ..:r.~:, Roc Filled Yes ( No Q SEEPAGE PIT Depth �S'F ------ Diameter ".. I Water Table Depth "..... Rock,$ize .:... .-- ."-. Prop. Line ..�5................. Distance to nearest: Well .. ...............�'C�`=`•� Founda„ t�,_�=- =6 - -- REPAIR/ADDITION(Prev. Sanitation Permit# ........ ........ . " • . . Dote "-------------- I Septic Tank (Specify Requirements) --`•............... I ------------------ Disposal Field {Specify Requirements) .-6-- -- - --T a --- • .......... F - .................. .......... ..""....----'- (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 licen- sed agents signature certifies the following- "I certify that in the performance of the work-for-which 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 .:". ... . .. -------- --- -------1----- ................... Owner Title .............". (I other than owner) t - F DEPARTME USE ONLY .-- I DATE . ..... APPLICATION ACCEPTED BY . .. .... BUILDING PERMIT ISSUED - ----- ............ .. ....... ......DATE -.__...- ADDITIONAL COMMENTS{. f et .... --- - .. - ... .. --•--------------- ---------------..... ..... ........ -.........- Final Inspection by: ....--- ------ ------- ------------------------ ...."........_Date . ---- - --------- • SAN JOAQUIN LOCAL HEALTH DISTRICT E723 ,4 1 1 24