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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 3_�03p (Complete in Triplicate) -------------------------- •--.,...__ Date Issued r� s 77 This Permit Expires 1 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/LOCA ON ,...... . e ...............•____...._...........CENSUS TRACT .............. Owner's" Name . .. . .................... u............ ........ ....y.. .Phone......................................... Address .:............... Z.;�.. _...-7 .......: --+:- � — - = •--• Cify. .:.:..... .'Y . ... ..... ........ Contractor's Name .._. rrr -_ :____.•_. :.. ::Lice ' 1 . . _ = - � --- ---- ---- "'.:................ nse#-:--/.i��'.��:� Phone..r:'::::::.:--�-='.............. Installation will serve: Residence e4artment,Housej Comrimercial f❑Trailer Court' '❑ + S, Motel E]Other ...................... ............. Number of living units:.._....--- Number of. bedrooms ____ Garba a Grinder ............ lot Size.._..__ p F Water Supply: Public System and name ..... - ._.....---- ---• . -•-.Private .. ... ... . Character of soil to a depth of 3 feet: Sand❑ - Silt d Clay ❑ ` Peat[] Sandy Loam [Y Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Materia( -- If yes,'.fYPe _._..._..._. (Plot plan, showing size of lot, location.of. system' in relation-to wells; buildings, etc..must- be.placed`,.on reverse side.) NEW INSTALLATION: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,)( �s PACKAGE TREATMENT SEPTIC TANK f Size.: .J '..� .x._S�_... .. : [ f = : Liquid Depth .......................... Capacity � oQ.._.._. Type; MoterialeCZ).. .._ No.' Compartments ......... � Distance to nearest: Well ��o __.:__.. __Foundation lI` _ Prop. Line'---- .......... _ / c � LEACHING LINE [tJ . No. of lines ..__.�_____________ Length of;each line.____.--o_---- --____. Total length ?.. I 'D' Box f - Type"Filter Material ...._. _-.. ..Depth Filter Material :..-1- ..'................. ............. Distance to nearest: Well 'O._ Foundation :..:..r ._..:-Property• Line SEEPAGE-PIT ~[-]-._ Depth ..... ....... ❑ (3..-------- Diameter ----•-:-•.___--- Number .:.-•..:.........:...::..:..:Rock.Filled Yes ,...No Water Table Depth;-.....'............... .Rock Size Distance to-nearest:.Well ...:......:.. .Foundation _. ...._..... .................... Prop. Line_`----- - REPAIR/ADDITION(Prey. Sonitation',Permit# ...... ...............•_.......____ Date -- ............................... Septic Tank (Specify Requirements) ............. .................:...........................---•-- •••..:. . - ........... ---- ------------------- D --------•--- DisPosal Field (Specify Requirements ) .......................... ........ . -------•............... --:....._ .....> •...... ------ --------------------------------------------.................... .............................. .----- - :. .......... (Draw existing and r . ...... a 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 Joagain County Ordinances, State Laws."and Rules and.Regulations of'the-Sciii Joaquin Local Health.District. Home owner or IicerN sed agents signature certifies the following: "I:certify 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 to Workman's Compensation laws of California." `F 'Signed Owner ......... ............. .. i By ............... ------ .................C.!. :.: Title (If other than owner) FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY --= -_--•------•------=----•-•............ ............... DATE h_ -__'. :;................. BUILDING PERMIT ISSUED :............. ...:........: •--:.... ......................................... r-•-- ....:....,.DATE ..............................................- ...:. ADDITIONAL COMMENTS .................... : _ .............. ........... ............. .------- •"----------.•---____•_.......__._........ _ ._ _ _ __ .�I _ •• . ......... .....:....•.i -_-_-_--_ -_---I ---_._ ._ _.__ _ _ ;.!"�-sr". .. - Final Inspection by: ......, :... . . ------,---- - ------ .-- ..... Date, 7 :- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 241-'68 Rev. SM 7172 3 M