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FOIL OFFICE APPLICATION FOR SANITATION PERMIT j !Complete to Triplicatel permit No. ...77. ........... ...................... .. ............... This Permit Expires 1 Year From Date Issues Date Issued /_ ........... Application is hereby made to the San Joaquin Local Health District for a permit to condrtw t and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: X11 p� JOB ADDRESS/IOCATION ...��° �.3 ...�..�.�............./� .........................................CENSUS TRACT .......................... . ....... ..... Owner's Name ...,�.�e�.I�GCIJ.....:, ` �i� .l '.....................................................................Phone,,5.r, Address . . ................... ..........................................................City .. .... 1 � ........................................ Contractor's Name ..... . .r -....!.:`l ....................................License*a . Phone . installation will serve. Residence II Apartment House 0 Commercial[}Trailer Court Motel❑Other ................................. ' Number of living units:......I.... Number of bodroams .Z....Garbage Grinder ............ Lot Sire ..../. .................... Water Supply: Public System and name ..............................................................._..........................................Prhrate Character of soil to a depth of 3 feet: Sand D Slit❑ Clay Q Peat❑ Sandy Loom I day Lawn❑ Hardpan❑ Adobe Q Fill Mcterlol ............If yes.type........................... !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse •klo. NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sever is available within 200 feet,} PACKAGE TREATMENT ( ] SEPTIC TANK,K Size................................................ Liquid Depth .......................... /r/�7lfJG' Capacity .................... Type .................... Material...................... No. Compartments .................... Distance to nearest: Well Foundation .. Prop. Line LEACHING LINE ( } No. of Lines ....................... Length of each line............................ Total Length .......................... �xlf7�A/1 D'.box ............JVpe Filter Material ....................Depth Filter Material ............................... - . Distance to nearest: Well......................... Foundation ........................ Property Line ...................... SEEPAGE PIT ( j Depth .................... Diameter ................ Number ............................ Rock Filled Yes Q No Water Table Depth ..... ........................................Rock Sin ................................ 40 Distance to nearest: Well ........................................Foundation .................... Prop. LMe ........ ........... REPAIR/ADDITION(Prov. SanWation Permit#............................................ Date ..................................) SepticTank (Specify Requirements) ........................... ..... .............................»......_...................._............_................ Disposal Field (Specify Requirements) ..., �! ... . .......7,0.............................................................. .................................................................................................................................................................................................. ..........................................._............................................................................................ (Draw existing and required addltlon on reverse ski) I hereby certify that I have prepared this application and that the work will be deme in aha with San Joeiquln County Ordinances, State Laws, and Rules-and Regulations of the San Joaquin Local Hearth District.Home owner or Reim- sed agents signature certifies the following: "I certify that in the performance of the work for which Nils permit is Issued, I shop net employ any person in such manner as to become subject Workmen's Compensation laws of California." Signed _... � ............ .............................................. Owner By ..... ................. ............................................................................... aitle ........................................................................ (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . ....... ........... DATE ../— _d..7.24 ........... BUILDING PERMIT ISSUED ..DATE-.......................................... ADDITIONAL COMMENTS ...... ............................................................................ ._ .....11 ..... ................... ..----•--•----............•-•------............................................................ ................................................-- ........ --- ...... ............ ---..... ........... ... ....... ............. ............ Final Inspection by: .....-- Date ...�... . ....� .. .. ...... ... .. EH 13 21t 1-60 Rev. 5�1 SAN HEALTH DISTRICT 8/7h 3H