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OR OFFICE USE:..� APPLICATION FOR SANITATION PERMIT X Permit No. ..................... _.:.......----------.................................. (Complete In Triplicate) - Date Issued ,�'.............. , ThIs-Permit Expires t Year From Dah Issued ! . • q No. 549 and existing Ruins and Regulations Application'is hereby made to the San Joaquin Local Health District for a }permit to construct and install the work hes described. This application is made in complione with County Ordinance 0N ...............CENSUS TRACT ........................... 3013 At3DRl:SS/t©CAT4 ..... Q.�.�r .._ '��. ..._ :.................:.....:................. r. ......Phone .,��'"Q ...� Owner's Name .. -••• � . Address ......city ...... a:��f ........ . . ..... ............. Contractor's Name TlAanse # ..:......;.............. Phone ...............:. -: Installation will serve: Residence®Apartment House I-] Commercial OTraller Court 0 tik` i Motel ❑Other--•_:..............:....:.. .........:...... Number of livingunits;....../ Number of bedrooms Garbage Grinder ............. Lot Size ..................... ....... .... . ....Private 0 . Water Supply. Public System and name .........:.........:..:_ ............................... l Character of soil to a depth of 3 feet: Sand U. Silt Q Clay .0 Feat(Q Sandy Loam. Clay Loam Q Hardpon o Adobe or Fill Material ............'if dies,type ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.is available within 200 feet,) PACiCAG1 TREATMENT [ } SEPTlC TAMC{ Size....................... :._ Liquid Depth ...........................L . ........._,.:. Materlat....................... No. Compartments ..................... I capacity .................... Type .... ._ Distance to nearest: Well ,.Foundation ........ Prop. Line ...................... ......: ......... ........ Length of each lime.----......_.._............. Total Length ........ .............. LEACHING LINE No. of Lines �. 6 ( }. ..::_.:. Type Fit#er Material .-.-...-•.:•:__.....Depth .Filter Material ........................................... 'D' Box r A� Foundation ............ .... .. ..... Distance to nearest. Weil ....:� .:..._._. Founds �• P$rtY .' . Property Line ar Rock Filled Y i SEEPAGE PLT [ } Depth ... . Diameter ��._....., Number c�..-«-••••••• r es � a ..`.._."._�' '� ` .Rock Site . ��..�.............. N V Water Table Depth ..__...... � ...In •... . .. " '...---....Foundation L.«.. _ - Prop. Lute ................ �Distanao to nearest: Well ....1,.-S• --- ..-_ ....-- ___ Date A RhPAllt/AtiDIT10N(Prev. Sanitation Permit 5P .--:••--••.:.......:..................... 1 Septic Tank }Specify Requirements) • .................... ........ , Disposal Field (Specify Requirements) ---- - _._ ------ - ................................. ............. --...... ............. ¢, •...... ....... ........... ..................•^--^-.....__.r.---......_..._............................. . (Draw existing and required addition on reverse side) I hereby certify that I have piepaied this application and that the wank will be done la accordance Wills San lr I co n County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin Local'Health.DWrict. Home owner or lice::- sed agents signature certifies the following: rson In sttth macular "I certify that in the performance of the work for which this .psg*dt is issued, 1 shalt not employ any as to become subie t to orkman's Compensation laws of California." f�,,� • --------------- -•--•------- Owner Signed �ic. ---�•------- - ••-------- Title -_------------ ................ ... _..... ................ (If other than owner) FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY __ . _ DATE .. _ .-Z- _ _... •- ..... ---- __ j BUILDING PERMIT ISSUED -----.-- ------------- --- DATf ..... .. -- k ADDITIONAL COMMENTS ...................__ ..-.--.....----.----._._.-..._..__,.._,..._.._...._ ----------------- • ------------- ----------------------------- ------------- ----- i • --------- --- ..._ ----------------- Date .. ........................_.......... _ Final Inspection by: [s � EH 13 24 1-68 flev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M