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R OFFICE IF - APPLICATION APPLICATION FOR SANITATION PERMIT 7 7- . �/ fComplew in Triplicate! Permit No. ..................... ........ This Permit Expires t Year From Do*Issued Date Issued �`� 77 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 ReDulotionsc JOB ADDRfSS/LOCATIO J!" .............................cases TRACT .......................... ys Owner's Name ..................... M- .......................................................... ... ...................................Phone ....._.._.._--•-----...._._....--•_- Address -- ---------- ------ . y --•---•............... ....I.. City ..............•.....•...... .......----•-•-••-..-------------. . ----------1- GContractor's Name # 'Phne .......%/` Installation will serve: Residence b(Apartment House J3 Commercial❑Trailer Court ❑ Motel❑Other...... Number of living units:... Number of bedrooms ---.r"1...Garbage Grinder ............ Lot Size .....AfIR � ....- Water Supply: Public System and name -------------------------------........................._......._.........._...............................Private` Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan Q Adobe❑ Fill Materlof............If yes,type............... ............ (Plot plan, showing size of lot, location of system in elation tor well:, buildings, etc.. must be placed on revere side.l� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200,feetJ o PACKAGE TREATMENT f ] SEPTIC TANK Or Size ...... ....... .--••- •-•---... Liquid Depth .......................... Capacity /%0d........ Type R . MaterlaaA��No./Compartmerft .V--, ... Distance to nearest Well �� -.. ....Foundation.,� ... ..._ Prop. Line ..�, .....- . LEACHING LINE No. of Lines Y .__.. Length of each If . Total Length ------� Q...._. 'D' Box .. ,1 e � � 1� ./ Type Filter Material if . .... after Material ...If................ .....�.-- Distance to nearest: Well ... OD......... Foundation ..f...Q......... ... Property Line Q.......... Y SEEPAGE PIT [ l Depth -------------------- Diameter ................ Number ...................,.. Rock Filled Yes ❑ No ❑ WaterTable Depth .........-••---•••.....-••-•-••.................Rock Size ................................ Distance to nearest: Well '..Foundation .. ....... mop. Line REPAIR/ADDITION(Prev. Sanitation Permit t# ............................................ Date .................................. Septic Tank (Specify Requirements) _........- ..... ... ................. - •.....:......._.......... ........:._............._........ • DisposalField (Specify Requirements) -•••-----•.............................................................,.............•-•••••....:.._......••..............•..-------- --------•---------------- ------------- -------------------- -----•-• .................................................................................................................................... ---•---•---------—---------------------------------- ................................ --------------------_............................................................................................ (Draw existing and required addition on reverse sidef I hereby certify that 1 have prepared this application and that the work will be done in aaordance'with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin vocal HeaW,District. Hem* owner or Ilton= sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit Is issued, i shag not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed :.. - ------ ---- ......•. ....... ... .......... -- Owner By ' / ............................... . title - �' �... _Z._.... (I€other than owner) _ FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY __. . .. .. ..... ... .... ...... ......... ...... ,._..,......... DATE .__. �" ..._..'..7 BUILDING PERMIT ISSUED ... ........................ ...... DATE ADDITIONAL COMMENTS .._/--V./`----- •-- � �f ._...4..�G-........`� ---------------------- _._..................................•----.--.......-------------..........................---.....--- ... ----- - ---- .. ----..-------- ........... --- ---- ---- ------ n by: . - ....Date - -••-...Final Ins ectio EH 13 2!t 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M