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FOR OFFICE USE ;APPLICATION FOR SANITATION PERMIT .... ,- ICampteto In T �cc . - . . �............................. � � �/G -� ............ ............................................ This Permit Expires I Your 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 comp once with County Ordinance No. 549 and existing Rules and Regulations: .JOB ADDRESS/LOCATION .._ !/�l T _. _A`_'`;S_�•?_v'�.._____.litf.......................-......CENSUS TRACT .......................... may, ............. Owner's Name �l 1.. ... �!h. -..... ... .............................................Phone ................:................... Address _ r... ..........................I City ................................................... Contractor's Name ..._..__.�� . ............................License # ...... Phone etl-'-r................ installation will serve: Residence alApartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other............................................ .Sa X . Number of living units:.. g -____. Number of bedrooms,�....Garba e Grinder Size f...................... Water Supply: Public System and name .................... ............... ............._.....---..........................--___... ...Private IZZ.;: Character of soil too depth of 3 feet: Sand13 Slit❑ Clay ❑,� Peat❑ Sandal team❑ Cloy Loam ❑ Hardpan❑ Adobe V Fill Material A10-.If yes,We............... ............ ?Plot plan,, showing size of lot, location of system In relation to watts, buildings, etc.-...,must be placed on reverse side.) NEW,INSTALLATION: INo_se pticrank.p► seepage pit permitted if pu§llc sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK( Y_ _ ize...0 0-....7..., .... Liquid Depth .1� Capacity's ). Type�lt�..L.F�... Material . --. ...... •No. Compartments ..�....... ' Distance to'nearest: Well .................yx ..Foundation./.. .....:: Prop. Line� .___...... -- - --- �'.4 1 EACHING LINE [ No. of Lines .__..!a�............ Length of a ch Total Length 1.^�.. •... ......•....... / `D' Box .:. Type Filter Materia! ..1 `�a....... Depth"Fllter�Matarial-�J .r�...........�. .........._ Dista to neareit. Wel! .. . .. Foundation_'./.2.............. Property i.1ne . .................... SEEPAGE PIT Depth ....... Diameter .�..... Number ....Z;L.....,............•Rock Filled Yes No ...... i ..................... ._.. + .1.11...... /' Water Table Depth [ :Rock Slsa . .�:Z.. t Distance to nearest: Well �`bQ.........................Foundation J0..►......... Prop. Line ..-.. ........... REPAIR/ADDITION(Prov. Sanitation Permit# ......:..._. ....:.. .`.. . --_ Date ............. !..... � f Septic Tank ISpecifV Requirements) .............. .. ...•_......... ............. ...................... ........................ .. . 'I Disoosal Field ISpecify Requirements) ° ---.....-•---••......................... ------------ - - -- ---------- - --••--•-------.....---........!....................••_•_•_•-•_•__...---'---•--•._..... -- _........ *...... . ..................... _-............_---------------- .........._--_ -......_ �_..-- Draw existing ._.n and required addition on reverse side) t I hereby certify that have prepared this application and that the work will,xbe doe-In accordance with San Joaquin 'County Ordinances, State Laws, and Rules and Regulatlons of the San Joaquin Local Health District. Hance owner or licen• sed agents signature certifies the following: E "I certify that in the performance of the work for which this permit is issued, I shelf not imploy any person in `such manner as to become sub[aetto Workman'i Compensation laws of California." I a- ned p- Owner By ..... ................. wf�:. _. _ :.. :..... . xitle . ... .. ...,... (if.other than owner). ' I ' k FOR DEPARTMENT USE'ONLY `" -.. APPLICATION ACCEPTED BY .............. DATE . :? .:.......... BUILDING PERMIT ISSUED ....-77' — _'-'`- .....DATE--:-.,. ---...*"':............................•----•....._._.........----._......._....__... ADDITIONAL COMMENTS ................:' .:...- :.........� ...._. ..---.-......---.- 3 t. e ................................. -----=............... .......... --..................`.......:............................-,,.-........--...... ...._..._-..-..-.. f f ........ ....... .. ...-..------....................- ....._.._. ...... Final inspection by.. ...............•-_. .. ..........................-.-.......... Dale ...� �f 13 21t 1-69 v• SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M