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FOR OFFICE USE: ': APPLICATION FOR SANITATION PERMIT , 6/ ..... Permit No ................ IComplete in Triplicate) .. �. .;. ,�-, ... ssu ,. / oto`'? � -" ,- . ate 1 . ed . ...... .... This Permit Expires 1 Year from Date Issued E 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 Na. 549 and existing Rules andRegulations: �Z ...... .... ._.../ y c ....:... ........_....CENSUS TRACT RACT.. .........JOB ADDRESS/LOCATI No / ....... Owner's Name ....... ................................................... ..........- -_....Phone . r •� Address 11�W l..... .. .. City _../er r .:..................... : ... Contractor's Name .........................License # *;4W_Z9r .. Phone . .__ ". .:. . .. .. Installation will serve: Residence Q Apartment Hous,eo House. Commercial❑'frailer Court �. Mote! Other_ ,C i ....... / .......... )Number of living units:...!...... Number of,bedrooms .........Garbage Grinder ............ Lot Size..... ..... �'..�_-•.� ..Q--- Water Supply: Public System and name" .....................:....... va ! ` Private Character of soil to a depth of 3 feet: Sand 0 Silt© Clay ❑� ;Peat❑ Sandy Loom 0 Clay Loam ❑ Hardpan Q Adobe flPili Materia! _..-----.... If yes,type............... ............ (Plot plan, showing size of lot, location of system.ih relation to wells, buildings, etc. must Abe placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage .pit ,permitted if:public sewer is available within 208 feet,} } ` PACKAGE TREATMENT 11 SEPTIC.TANK I ] " , S IS—............................................. Liquid Depth ......................-_-- Capacity --•-------------'._.Type --- Mc#erial------------.......... No. Compartments ...........---....... Distance to nearest: Well .....Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ...............------.� Length of each line ......:................... Total Length ............................ C� z 'D' Box ..... Type Filter`Material ....._.Depth-Filter -Material ............................................. Distance to nearest:-Well ......:................. Foundation .....i................... Property Line ........................ SEEPAGE PIT ( ] ; Depth '•..• .- Diameter _--------_-- Number ............................ Rock Filled Yes ❑ No (:3 Water Table Depth ...Rock Size ................ i Distance to nearest: Well ----___.____•.......:...... •-----,.:..Foundation ._......._. ... Prop. Line .---.........•--.---• REPAIR/ADDITION(Prev. Sanitation Permit# -•--•----•-=-•----------•--... __ Data ...•..........................-- ..� Septic Tank (Specify Requirements) ...:, . Disposal Field (Specify Requirements) ...................:. -�...... ......... .g --------- ----------------- __________________________ _____. ------------------------ _-------•. ..-.......-_-.•-----.-_._........._... �' (Draw existiand . quired addition reverse side) I bereby'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. Home owner or Own- 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." Signed --------------- - --- --.---- `- :_ ... ----- -------•------------- Owner BY ----_---------- T (if other- ----��••••.• _.. �-----• ..............--•---...._.., isle than owner! FOR [CEPA ENT USE ONLY APPLICATION ACCEPTED "8Y- -.� �. "... - /.-.:Z� 7-77... .. ------------ • ......... . ...............................•---- DATE . .. - BUILDINGPERMIT ISSUED --------------------------A...--------------------- ------------.----------••-----•-•--. --11...........DATE _ ...................... --------..-.. - ADDITIONALCOMMENTS ......................... ..- -•-•--.........,...---..............:.--•----------------------------- -•---•---•------------------- --- --'- , . - _._-.._..--•------------- ..... - , •-------------,---................ .• •--•---------------------------• -----•------- --....--•-------._-.--• -------------------- - —----- --- ---------- -- • � ----------- ---- .................. -------------------------------------- --- • --•----- .......------...__------------- ....------- --- . fins) Inspection by,. _... = : :.................Date . ... ................. ...-•--•... EH 13 24 1-68 11ev. 5M SAN JOAQ LOCAL HEALTH DISTRICT 8/71; 3M