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F1JR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................ .................................. (Complete in Triplicate) Permit ..................... .......... Date Issued ..SR.�7.76 1- f...�..............•--............ 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 Regulotionsa JOB ADDRESS OCATION .._.Z3..7- ..... � �Oi� ,?�� ,ENSUS TRACT .......................... Owner's Name -.. ..��.TC-------...��---•-•----•........................ ...................................Phone . .�6�& Address ............City . Contractor's Name -__ # .a1..73.. Phone ......... ...... Installation will serve: Residence rtmont House❑ Commercial❑Trailer Court ❑ Motel❑Other............................................ 3:.....Gar a Grinder Lot Size ...ZA*r:r:- Number of living uni#s:_....�.... Number of bedrooms bag ............ ............ ............ Water Supply: Public System and name .--- ----- -/�----------•-.._....................__...................................................Privai 0 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Foot❑ Sandy Loom 0 Clay loam ❑ W Hardpan❑ Adobe❑ Fill Materlol............ If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)r NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) V PACKAGE TREATMENT ( j SEPTIC TAMC Size...�,:lX.. .. 15...9................... Liquid Depth .......................... Capacity,1.2�. Typo&,6. egrl-Material.-n '. t o. Compartments ....Z. .......... Distance to nearest: Well oxer. .................Foundation 1 a... Prop. Line ..../OQ,.,,,- LEACHING LINENo. of Lines .........7---------- Length of each line........7 '........ Total Length ......1. .'...... 'D' Box / Type Filter Material Depth Fitter Materia! ............lel ' Distance to nearest: Well ./P) ........... Foundation ......:�Q.......... Property Line ........................ SEEPAGE PIT Depth ......?_-�..... Diameter ....,M3."'Number ............ --........ Rock Filled Yes EY--'No C3 Table Depth ,,7.Q...........................Rock Size --....Y Distance to nearest: Well ......,16- . .................Foundation ...../.,d:-'...... Prop. Line ...l4.J........ REPAIR ADDITION Prev. Sanitation Permit# ............................................ Date ..................................) SepticTank (Specify Requirements) ..............................._................................................................._............................I............... Disposal Field (Specify Requirements) ....................................•-----....... ---------------•-------------.------.----- --...-----•-- ------------ ------------------------------------------------•--- -------••-----...-•-•--•--•--•--••---•---•---.............-----•........................................I....... •---------------------------------------------------------•---- ............................................_........................................................ ................................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be-done in acewdmee with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.©istrid. Monte ewner or licew 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 AxAen: . .... Owner By , J .-_--------- ............. ...------------............ -. :tie (if other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ..... DATE BUILDING PERMIT ISSUED ------ ------- ----------- ---------------- ......•...... .---------------- .--------------------.....DATE -_...-................................... . ADDITIONALCOMMENTS ------ ---. ......................................•- -----•. --..:_---._................................ ------ ..............................-... FinalInspection by: .............. C- ...................... ----•--- ............................. .. .2 �a..........--- ...-....Date ......�....------•---- -- EH 13 24 1-68 Rev. 5m SAN JOACQUIN LOCAL HEALTH DISTRICT 8/74 3M