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_ APPLICATION FOR SANITATION PERMIT f 1R •EPIC L�E; � � - Permit (Complete In Triplicate) ............._....................................---- Date Issued .......................................-----............. This Permit Expires I Year from 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 .--..l.I�Sl._. __. �` ---i l!t6 ..- s �` ' � ...............CENSUS TRACT .................:........ Owner's Name �l �. ...............:........--------- ............................... : Phone' .a .1`�� ._.....• Address _........City ...... . Contractor's Name .. fits'`.r11c �` --.....---•----..License-��.. Phone �._. Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court Motel ❑Other.......... ................................. Number of living units: .. Number of bedrooms -,Z--Garbage Grinder ............ Lot Size ..........-............... ................. Water Supply: Public System and name ..-----.-•...----..._--...-----••-•........... .........................---_-..................Privateer Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Lodn(2L__� Hardpan ❑ Adobe 0 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 if public sewer is available within 240 feet,} PACKAGE TREATMENT SEPTIC TANK f j Size�. . ?l��?1................. Liquid Depth ........................... A&V...._.. T e6e � Material. No. Compartments ................. Capacity Yp ---- -•--- Distance to nearest: Well.....................Foundation ._j ._.......... Prop. Line ......................� � s � W,---No. of Lines _..........._ _ . 14- LEACHING LINE - � T ! Length Q 'D' Box y... Type Filter Material/cazXal.Depth -Filter Material ._... ... ........................:......... r Distance to nearest: Well ---- .....:....... Foundation _....................... Property Line ..........••••••-- ..... SEEPAGE PIT I } Depth -_-.---__------... Diameter ________________ Number ............................ Rock Filled Yes ❑ No ❑ • Water Table Depth -........................... •-•------ .........Rock Size ................................. ' Foundation Prop. Line Distance to nearest: Well ----------.-• .............. REPAIR/ADDITION(Prev. Sanitation Permit# ---- ----------•---------------------- ...... Date ..........................•.------ 1 Septic Tank (Specify Requirements��4l5t`/�!u .A------ ......-------.-...--........... Disposal Field- (Specify Requirements)7`�__..__� '� - _. — _ I -___- .SS ------•• --- /_ ,rte k ------ -- . f - - (Draw existing and required addition on reverse side) { 1 hereby 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. Horne owner or licen- sed agents signature certifies the following: "Ccertify 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 Workman's Com ensation laws of California." Signed .............:. ..... . ....... . -- -- -- -- -�- - --•- Owner .............. .................. Title -- -------- -------------•--- ...................... . other than ow yFJOR EPARTM T USE LY i APPLICATION ACCEPTED BY ------ -- - ..... - .. ......•-- ----- -------- - ------ ----- DATE BUILDING PERMIT ISSUED ------- ---------------- DATE ... ` ADDITIONAL COMMENTS --_-__-_--------------....-----... -- ••------.---- ..--..- •------------•-••.............._..--------•-•-----.......--------.-_-.-__-__-_-------------..._... -----------•-.-----_ - . .......................................................}.--mss_-s.___--- - Final Inspection b Hate ..... .-.-.�� .. ' E;H 13 2h 1•-b8 Rev. 5'M SAN fOAQLIIN. LOCAL ITER DISTRICT 8/71; 3M