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FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT ,�-�--- --------••.......... ...................�...... Permit Na. ....7 _.:.----- ompf to in Triplieato) Date Issued 6 7 ' This Permit Expires 1 Year Fret" 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: p JOB ADDRESS/LOCA ON ... ..... .�62�0_ ...... ./ ....................... ......................CEN5U5 TRACT .......................... Owner's Name . , :- •....:.................................................. ................Phone ............,....................-.. S� ��"�_ .... City f..9 .r3 Address . ...-. 7... ...... t Contractor's Name .. -' .. . ... .... ..::..... ......::.............License # Phone ......:....................._. installation will. serve: it Residence artment House Commercial ❑Trailer Court I] t i Motel ❑Other.._:........................................ Number of living units:-.: _`. .'Number of bedrooms"..:::: _._.Csarbage Grinder Lot Size :.......:... .:�i?•o y 7?s.....:rte Water Supply: Public System and name .T•` ------••......................................_........._........................ .. ..............Private Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay ❑ Peat❑ Sandy Loam e Clay Loam ❑ Hardpan p Adobe 0 Fill Material ............ If yes,type...............:............ Plot•:�. -_.T : ( plan, showing size of lot, location of system In jelation to wells, buildings, etc. must be placed on reverse side.) NEW tNSTALi', T10N. INo septic tank or seepage pit permitted-if-public sewer li available within 204 feet,) fk PACKAGE TREATMENT � e SEPTIC TANK ' :.Size::��::�X-:1'�-X. ........... Liquid Depth ••-•- t Capacity - --------- Type Material----- .- -- No. Compartments .... ...... w Distance.to nearest: Well I ' . ®� � ::..Foundation .....�.o:�,-P.`_-... Prop. Lina ..�:�..� 0 LEACHING LINE ( J� No. of Lines ---------- 3---------- Length of each line...---- 0-At ........ Tota! .length ........ ...dry _..__.. W 'D' Box .....1:----. Type Flit Material .. S. ......Depth Filter Material .:.a... ....'�......... ..••••._...... N .... Distance to nearest: Well ..,�:j.�.:Q:9.�:.foundation Property Line ...... z SEEPAGE PIT [ j Dep th ----- -------....... Diorneter ......~:::.:_ Number ............................ Rock trilled--Yes ❑ No`Q - Water Table Depth s -•----•-:-••---Rock Size Distance to nearest: Well .......... ...foundation Prop. -Line .: `.................. VP �i REPAIR/ADDlTIONIPrev. Sanitation Permit-#......:....... . '" Date ................................... ) Septic Tank (Specify Requirements) ............... ....................................................................................... ...... ...................... Disposal Field (Specify Requirements} ----------------------- ---------------------- ------•-----...---------...-............. ... ---------------------------------•• -----------.--- -----------•--.--•-------------------.-....-........---------•-----..-..-•-------..-...............-.......----•---- ------------------------------------------•--------- ------------..............-......................:........................................ ............... (Draw existing and required addition on reverse side)- s I hereby certify that i have prepared this application and,th ai..the�work swill-be.,done in-occordance.;with..San.,Joaquln County Ordinances, State rtLaws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner or Ilcen- sed regents 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 By _-----------•--------------- '�-- ..... ------ Owner ------------- . .... ............. (If other than} owner} I� F Ef EN"t E N APPLICATION ACCEPTEDB .II_ Y BUILDING PERMIT 15SUED - ----------------- ------------•-----•-•-•--•-- --• --•---- ....... ...DATE .....------------..-. :.. ................. ADDITIONALCOMMENTS`.............................................................................................--..---------...----------.....--.-._.:.................---.-..... ---------------------------------•----- ................................. -•--------------------.........................................................-........................... ,M ..............•-----......-----..•..-- --•----- --•--... .........-.. •----•-• --//- ... �J Final Inspection b 0...... .--.. Date 6.` ./ ------ ------------ ---- EH 13 2h -6 SAN JO Q IN. LOCM HEALTH DISTRICT 8/74 3M it ..,