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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .......... . . .�....---...---..... _ -.. �Q (Camplete in Triplicate) Permit No��.-,1�� ..... ......... .. ....... ....................... � This Permit Expires / Yew from Date Issued Dots Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal) the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.371,l...E..._,A.cc.mp-o...Rd, ................. .,..CENSUS TRACT A:campo Owner's Name ,_Lo xiS...Rhen.............................•---............................,......... .................... .......Phone36802.7................... Address Same _........... .__... ._...._... ..........................city .. ...... ... .. _.... ..........-. ...... ......... .......... ,..,.... Contractor's Name G...&...C'..Se�?t-1.0...Tsux..,Sex.................................License #307-.57.-2,1..... Phone .3. x,393.'3........... Installation will serve: Residence b Apartment House C] Commercial ❑Trailer Court JJ Motel❑Other........................................... Number of living units:......_..... Number of bedrooms ............Garbage Grinder ............ Lot Size ......... ................................ Water Supply: Public System and name ........................................................._....................................................Private ❑ , " Character of soil to a depth of 3 feet: Sand D Silt 0 Clay ❑ - Peat❑ sandy Loom Q Clay Loam❑ Hardpan 0 Adobe❑ Fill Materlai ............ if yes,type ............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated on reverse side.)" NEIN'INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK{ I Size................................................ Uquid Depth .......................... Capacity ....--.............. Type -------------_----- Material...................... No. Compartments ...................... Distance. to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE [ j No. of Lines -------------------- Length of each line............................. Total Length ............................ 'D' Box ......_.... Type fitter Material ....................Depth .Filter Material ............................................ Distance to nearest. Well ........................ Foundation ---..................... Property line ........................ SEEPAGE PIT ( j Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth ................................................Rock Size .....---•....................... Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# .........._................................. Date ..................................). , Septic Tank (Specify Requirements) ---------- ------_---.--_--- ....... ----•-......------........--------•--...............................................--•............... Disposal Field (Specify Requirements) 60'• of_ 4"__ tight line-•to 14"_ "D" Box and then. .......................................................... 95'_ leach- line with sump__ ' wide 12 ..deep and. Y20' longi -- -- ------------ ------------ ---------....................................•------------..-....-....-.............................. Draw existing and required addition on reverse side) 1 hereby certify that i have prepared this application and that the work will be done M accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heath.(District. Neste owner or licen- sed agents signature certifies the following: "I certify that in the performance of a work for which this permit Is Issued, 1 shell not employ any person in such manner as to become subject to W man's pensation laws of California." Signed......... .......... . ----• - Owner By .......................... .. . t-- -------- . . ------ ..........-•-........... Title Owner - G & G" Septic 'dank Ser. (tf other t on wne _..-... _................... F.OR-01PARTMENT USE ONLY APPLICATION ACCEPTED BY _ ... ._ ............................ ......... DATE 1!0 _Z .. ..... BUILDING PERMIT ISSUED •-- --------- -- :.......... .QATE . ...J .._... •.- ADDITIONAL COMMENTS ---- ........... ................ :.-..... - .... - ................................ Final Inspection by- ------------t�•--- -...... -- •-•----------................. .. ,. .. ....... .. ....Date /.A��-�. ..?.�................ .. ... EH 13 2h1-68 �', N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M