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rvx OFFICE USE ... /rICE APPLICATION FOR SANITATION PERMIT 4.4 `� 0................ Permit No76..:... •---fE�npfete fn Triplicate) . ............................................ This Permit Ex ires 1 YeaFrom Dab Issued Date Issued .... .. Application is hereby made to the San Joaquin local Health District for aper mit to c TI N onstruct and Install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESSAOCA ...c�' �` ... . ..... f. .,. . _.�... .. . c C CENSUS TRACT ....... .......... Owner's Name ... ................... .. yYi j4 � .. Address _..---•- .... ...................Phone r....:.. ... .Y° city Contractor's Name ............. E:i? :e-: � ��;.........._........Ci .. :�.............................................................. ........................................... .......License ... Phone -•`--"""""""""""'-' Installation will serve: Residence-4 Apartment House❑ Commercial❑Troller Court ❑ Motel❑Other........................ Number of living units:_..--.-.- Number of bedrooms -2. .Garbage Grinder Water k Sy and ._.... lot Size ........ -•-••--•.................•--..... Supply: Pubo stem name ..... -� Character of sol!to a depth of 3 feet: Sand❑ Silt❑..- Clay........._Peat`....... »..........................................Private❑ 0 ❑ Sandy Loam❑ day loan, ® 6 Hardpan 0 Adobe❑ Fill Motorial ............ If yes,type-.......................... !Plot plan, :hewing size of lot, location of system in rekttlon to wells, buildings, etc. must be plated on revere tide.),, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK f j Size..•.....- Ca ................................ Liquid Depth ....................... Capacity ........ Type .................... Material...................... No. Compartments Distance to nearest: Well ....................................Foundation .................... BEACHING LINE [ ] No. of Lines ............... . ...............----... Prop. line .................... - Length of each line............................ Total Length ............................ 'D' Box ............ Type Filter Material .............. Depth Filter ......Dep Material ..................................... . • Distance to nearests Well ........................ Foundation [ I Depth ............ Property Line ...................... SEEPAGE PIT Diameter ................ Number ............................ Rock Filled Yet ❑ No Water Table Depot ................................................Rock Size ................................ ........ .. ..... . Distance to nearest: Well . ......................................Foundation REPAiR/ADDITION(Prov. Sanitation Permit ...1.3..!.1..J...................... ....... . . . mop' Line .........»......... Date •) Septic Tank (Specify Requirements) ..................... ... ............ Disoosal Field (Specify Requirements) -=.r....... ................... . ..... .......... .°.. ... .............................•.............-•--- ............................................................. (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 ecewdence with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to beconwsubiect to Wor a 's ens on laws of California.,, nec!(. � ..... Owner (If other than owner) . Title FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . BUILDING P DATE .. ..' :.76..:..;•,-,- G ERMIT ISSUED ..................................... .............. .. ....DATE,................................... ADDITIONAL COMMENTS .... "'"""""" ' """' ................................................... ........ ................................................... Final Ins ection b v....................................... .. . .............. p y: ........ .. ,e'.. . Date .-A lT . ................ EH 13 2!t 1-611 y. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711