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FOR OFFISE USE: S APPLICATION FOR SANITATION PERMIT (Complete in Triplicate? Permit No. . ......� ----•.................. ...__._. ....... _.....��.,._ :. ............................................. This PermitExptres I Year Fro Dateksoed 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 . ` J �eL..7........ ./.�h•D.xL..f .... .............CENSUS TRACT ....,..................... Owner's Name Phone .,.•. �1..._.. ._ . . Address .. ........ �.�.-... .. 1 .j.�... Ci ty .. .wr.G.. .......... .. .._f.............. Contractor's Name'--_-- --- ._�__. ../.t:._ ..- ...License ?'% .. L.. Phone ., .. . Installation "� ------- i will serve: Residence Q Apartment House❑ Commercial ❑Trailer Court Q i Motel ❑Other ... . . .11 ...................... " Number of living units:------------ Number of bedrooms orb a Grinder Lot Slxe,,l.�2../Y"Z .--- ............ Water Supply: Public System and name ......- _. ...............L ❑.. ................••----•....._....... Private Character of soil to a depth of 3 feet: Sand Q Silt❑ . Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Q 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 INSTALLATION: (No septic tank or seepage pit .permitted 1f public-sewer is available within 200 feet,) PACKAGE F TREATMENT f I SEPTIC TANK{ Size........................... . Liquid Depth .............. Capacity Type/VW-1. Material. ... No. Compartments " Distance.to nearest: Well ------------------------------------Foundation t.—.. Prop. Line .'...... i LEACHING LINE [ ) No. of Lines ......../------- ---- Leng th of ,,each line.--- .. ...,...... Total Length .. • ............... 49 D' Box ./.:_..._ Type Filter Material�� ..Depth Iter Material ...... .- Distance to nearest: Well ........................ Foundation ... D . . ....... Property Line "•. SEEPAGE PIT [ ) Depth -------------------- Diameter ---.-----.-:--.. Number -------------.............. Rock Filled Yes ❑ No 0 p 4 Water Table Depth ----------------------- .................Rock Size ------------._.................. EDistance to nearest: Well -------------------- ---.--..Foundation .................... Prop. Line .......................sc C REPAIR/ADDITION(Prev. Sanitation. Permit j# _.---__-.__-______-.._ " ---------------------- Date ............................... •) Septic Tank (Specify Requirements) --------------••-----•------------•----- ' Disposal Field (Specify Requirementsl _______________ .f _______________________».-.------------------------------------. iI (Draw existing and requires( 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 haws, and Rules and Regulations of the San Joaquin Local Health,District. !tome owner or licen- 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 become subject to Workman's Compensation laws of California." , Signe Owner ---------- -------------------------- xitie BY .. .. - (If other th owner) .....--- F DEPARTME USE ONLY APPLICATION ACCEPTED BY -----1. DATE -:.. I BUILDING PERMIT ISSUED - . :._.-.- ::'__".. ---. --.DATE..---- ----- -----•----•--- ---------------------------------------------- ------------ •--------•-._....---.-.------- ti .....................•-•---•. .....I-------- -------•---- .--------.. �---- -------------- .....................•-•-------------- --- • Final inspection by: .. Date .........`-.�� . .._. __. --•----- - -- --------- ------------------------- - EH 1 2 `�' may• SA JOAQUIN LOC HEAETH DISTRICT 8/74 3M