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PLM ur=Ftcc ubt' APPLICATION FOR SANITATION PERMIT ................ Permit (Complete In Trlpllcote) ............... ..... ...... ....... ... .... This Permit Expires 1 Year From Date Issued Dote 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 Ith Co my Ordinance No. 549 and existing Rules and Regulations, _/ JOB ADDRESS/IOC I N.,�f�� ...............................................................CENSUS TRACT .......................... Owner's Name ..... 4.... .... .. . .........................•. . .............. Phare ......-.._.......................... address /. . av ------ •.................................•--... City ..- .....- . . .. .......................................... -- -- . Contractor's Name ... ...licensef 5 3.1... Phony .7.loCl. ..... installation will serves Residence WApartment House❑ Commercial❑mallet Court ❑ Motel []Colter Number of living units:---- .... Number of bedrooms .-�....Garbage Grinder Lot Size / "� WaterSupply: Public System and name .--..--•----•-----•................_...................----...............................................••Private Character of soil to a depth of 3 feet: Sand E3 Slit❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe W Fill Material ............ If yes,type............... ............ ;Plot pian, showing size of lot, location of system In relation to wells, buildings, ate. must be placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) 6 ................ Li uid Depth ................. 6 i PACKAGE TREATMENT [ ] SEPTIC TAMC Yr' ,"el�-.��...5��... q 410 ........�j Capacity -lob..-_-. TypeP.A..�e . Material._�.t ...... No. Compartments ......••-• •....... ' Distance to nearest: Well ._,lQ_Q. Foundation ...... .,/1�............ Prop. Line ... ------ - LEACHING LINE [q'- No. of lines ---...r ............ Length of each line... f.". 5... Tata! Length .. � .r... 'D' Sox . . ..... Type Filter Materia! !.-I-- kDepth Filter Material ........................... Distance to nearest, Well ...... . Foundation ..Xwe)........... Property Line ............ SEEPAGE PIT ['f Depth ....... Diameter 33...... Number .........v;�... ....... Rock Filled Yes �'' No 'IfWater Table Depth ....... .e . .................... .c�..... . Rock Size 2.e2..�� 144 .......... If . Distance to nearest: Well --X5-4........................Foundation Ind..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ...................».............y SepticTank ISpecify Requirementsl ..-•.................................... ------................................»..........._........_. ..,...........--•--......... D;sr)osal Field (Specify Requirements) ................................---•...............................................-•---.._._......._.....----..:----.._........_.... ...........................•................... ................................................_............................................................................................ (Draw existing and required addition on reverse side) I heroby 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 Ilcen- 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 as to bec97a ub' ct to W mans Compensation laws of California. anec' ........ ...� --- . Owner By ..... ......... .................. ,/. .. . Title ........... ................... (If other than owned / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYEms' ...................................... ........ : . .�.........`: BUILDING PERMIT ISSUED ....... ......... .../�........._....-..._... DATE ADDITIONALCOMMENTS ...... ..................•....... ...............---.....-- --- .............. ....--- .. ...................................... ....-- ..--•.......... ........... .. ....... .....•- Finol Inspection by: . :,.,�..... Date .. .... 13 24 1-6 v. SAN JOAQUtN LOCAL )4EALTH DISTRICT 8I74 3M