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FOR OFFICE USE: „ } APPLICATION FOR SANITATION PERMIT4� -7 ........ ......................................................... Permit No./ -_,3 tComplete in Triplicate) . -.... ....................................••--..........._._ This Permit Expires T Year From Date Issued Date Issued �q�' � 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 *7L7 w_- .. i �..._ ..........................................CENSUS TRACT ................ Owner's Nam2�. ,..'- ... . rr : .rr �-Viz ..._.... . Phone ...7c ;.©1�� f� .. Address --- -f .� ` /�E.r': ..City .......-•- ... I 's Name ..................../ - _.. �'f! .License + Fs3 ,3..... Phone ._.rzq _: 9 Contractor . _ -. .... Installation will serve: Residence;KApartment House C) Commercial❑frailer Court C Motel ❑Other............................................. ( O Number of living units:-_-)..... Number of bedrooms_.-.--Garbage Grin*r ____-----• Lot Size___-- Water Supply: Public System and name .. ' :. .......Privat pP Y Y -•------------------ -......_.. --...... ..---... a k Character of soil to o depth of 3 feet: Sandi-] Silt❑ Clay;O Peas❑ handy Loam ❑ Clay Loam!f Hardpan❑ Adobep f€ll Material ............ If yes,type—............ ............ (Plot pian, 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 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK{ j Size.'... ......................................... Liquid Depth ....................,..... Capacity - Type Material._ ........... No. Compartments ........................ Distance to nearest: Well ................ ..:...............Faunda#ion ...................... Prop. Line ....-•-----• ....... LEACHING LINE [ ] No. of Lines ........................ Length'of each line---------- --............. Total Length ............................N Type ....:.-.Depth Filter Material 'D' box .._.:_.._... T e Filter Material Distance to nearest: WellZ....................f=oundation _... ................... Property Line ........................ TV SEEPAGE PIT .[ l Depth ------ ------------- Diameter ................ Number.............................. Rock Filled Yes ❑ No 0 . Water Table Depth --- = =---------------------------=----------Rock Size ................................ 4-- Distance to nearest: Well ... -" .'�...........Foundatian .................... Prop. Line -................_..._ REPAIR/ADDITION(Prey. Sanitation Permit# � _-___ _. Date ) �() I Septic Tank (Specify Requirements) -. . .....---•-----••--•-----•-••-• ... ...... ----------=--------••------•............................. , • me Disposal Field (Specify Requirements}............ -- . ... ....................... ............................................. t v r J 1. C S , ,.:............ = : __________________________________________ .. ______ .._ . .................... ........... ...................................... :(Draw exist g an required addition on reverse side) , 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heal&District. Hance owner or licen- sed agents signature certifies the following: "I certify that in the p ormance of the work for which this permit Is Issued, I shall not employ any person in such manner as to be ne sbject a crkrrkan' ,Comp@ cation laws of alifornia." Signed ��j", AAL-_-_ Q.d�i.._.. .__.a.. ., t BY ----------------------------------------------------- -- "Z�^ Title ....... . ........ . . ._.._. ............................. (€f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _,-__-. :- -- _ .- - - -------------------------------------- DATE _!}!.'3--__-76 ...... --------------- BUILDING PERMIT ISSUED ---------------- -- .DATE ------------------------------------------ ADDITIONAL ------------------_-----. - ADDITIONAL COMMENTS ..............I._........_ ....................` = = - ---------------------------- ..........................-------------._... .-......... ------._..:.. ------ ....................... .--------------- .------ .......... Final Inspection by .........................................Dote ..... •.................... 3 24 1-68 v. 5M SAN JOAQUIN -LOCAL HEALTH DISTRICT 874 3M