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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ............. ------------------- (Complete in Triplicatet Permit No. ........ .............•_.-__-............. :� ............ This Permit Expires 1 Year Frei" Date Issued Date issued ................. 6 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance nth Cou y Ordinance N 549 andel isti les and Regulations JOB ADDRfSS/L TION ..-..... g ` ....... . ........ ��> `.:...---...........CENSt1S TRACT ...�5-�0............. Owner's Name ............................................................Phone Address . . __- .......... ........City ..&lU�r�(t4gr-- Contractor's Name _ f�. � G ..'.:': .License # ........................ Phone .. ..f� installation will serve: Residence Apartment House Commercial❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:-.__I----- Number of bedrooms ......Garbage Grinder ............ Lot Size � Water Supply: Public System and name ...•..........................._...................._..............................._....................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0,'- Clay Loam ❑ Hardpan❑ Adobe 0 Fill Material ............ if yes,tyle............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, oft. must be plaoad on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 240 feet,( PACKAGE TREATMENT ( ] SEPTIC TANK I ] Size................................................ liquid Depth .......................... Capacity ---•................ Type -------------------- Material.............---...... No. Compartments ......................r Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................y LEACHING LINE ( ] No. of lines ........................ Length of each line............................ Total length op D' Box Type Filter Material Depth Filter Material % 100, Distance to nearest: Well ........................ Foundation ........................ Property Line ................. N o E P ( j Depth -------------------• Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 . Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well .........................Foundation ...... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit .........._. Date ..................................) } Septic Tank (Specify Requirements( Disposal Field (Specify Requirements . `_ . 9- •- 1�'�� ....................•.:7- •-- - .....--•---............................... . �/.......--••..................................................................... (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be donne In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Me",,District. Henle owner or (icon- sed agents signature certifies the following: "I certify that�iin the performof the work for wh ch this permit is issued, I shalt not employ any person In such manner as to becomebject t Wor. Compensation 1 of CaL19 rnia. Signed ............. ----� ---•-- ..... ..•..... Owner-- --------_ (If other than owner( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------ ------- ------ DATE .__._._........................ BUILDING PERMIT ISSUED ----------------------------------------------- ......... -------- .....--------................DATE . ..._:.. -------------........---------- ADDiTIONAL COMMENTS ...........................................•........... _,......-.-...-.. ---------------- ........................... ....................................... .............................•-- —.................... ...........-....................... .......... ......... ------. . ., ------.---. ------------.--..-,--------.---------._------------ --............--..-........... .... Final Inspection by- i.. Date . .� �-40......... . 13 21t 1-68 V. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M