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FOR OFFICE USE. APPLICATION ICOR SANITATION PERMIT IComplete In Triplicate) Permit No. ......... 3�% � 77 . This Permit Expires f 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 .. ! !_. CENSUS TRACT ........ lY(.�.._.._ .... Owner's Name . . ............... � � Phone ., ��/........... .... - Address GCr.._. City .... . ............,................ Contractor's Name .................... ....�..�. _ .... ...... S .......License #42.2r>. 3.. Phone .` �4. ..... Installation will serve: Residence(Apartment House Commercial❑Trailer Court ❑ ! Motel p Other............................................ Number of living. units:............ Number of bedrooms .........Garbage Grinder ............ Lot Size ....10................................ Water Supply: Public System and name --------------------•-••-................................_....................................................Prlvate'M Character of soil to a depth of 3#eat: Sand o Silt❑ Clay ❑ Peat[,] Sandy Loam ❑ Clay Loam ❑ .� Hardpan �& Adobe P1 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Q S. e....._ r r I ►�' x ......................... Liquid Depth .5 ............... � No. Compartments mentsCaPacitY Type --�------- ----- Material �......{-. .........�. Distance to nearest: Well ____._----/ .............--..Foundation ......!d�......... Prop. Line +_...... � ` LEACHING LINE No. of Lines ..---- Length of each line------- ................ Total length /f9P................. �� p rr - 'D' Box .___'Type Filter Material ._... §'fit- Depth .Filter Material ........kt............................ Distance to nearest: Well ..._.t9P_ta... Foundation ....ZQ.��__.._..- Property Line ................ SEEPAGE SEEPAGE P!T Depth .-_ S......... Diameter ....?.._3..�.— Number ..__.....�....... ....... Rock Filled Yes No i❑ Water Table Depth .......................... r Itntk Size .3/ url..2✓........... Distance to nearest: Well ........... ..........Foundation .. ..e?.... Prop. Line .. .. *`.--•-- REPAIR/ADDITION(Prev. Sanitation Permit# ---.•---------------_-.................... Date .........,........................I SepticTank (Specify Requirements) ---------------------------------- ............................................................................................ Disposal f=ield {Specify Requirements) -----.-----_---- ................................:..__.._........_..._..----....__........._..------------....----....----•-.,........ . ---------------------------- -------------------...-• - ----- -------------------------------------__..................••.................................•..................................... {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, Stat* 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 ------ -• --- ......... Owner By ---• •--- - --- - -- - - ....................•---- litle ----- (If other th wnerl R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............!,:A .-- - -..-- ..--------•------- --------------------------------------------- DATE .3 -1� � - ----- BUILDING PERMIT ISSUED ------------------------------------ ......................_..------ ---------------------------------_DATE . .--. ..................... ---------• ADDITIONAL COMMENTS ----------- ------- -•------•--•----------------- ------------------------- ------- --- ---------------------------------------------------------------------------------------- .......................................... ----- •------------------- - ----- - --••-----•--------- ---------------------- --.....------ .........................................ins ettion b PY --------------Date - -J-. ..7 .....-- -----.--.--- iH 13 2!t 1-68 Rev. � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M