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FOR OFFICE USE, APPLICATION ICOR SANITATION PERMIT Permit No. 7.. Coen lett In Tri licate$ .... .......4P p This Permit Expires f Year From Date Issued 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 Regulatlonst rvefl� ...---...... JOB ADDRESS/l.00AT N .. ....._ ....._ . .......',..................... .."�.....----�.-..... .......-,.:CENSUS TRACT ............. Owner's Name ... .!„ap.- ' ........... . ............. Phone ��A�:..c , 1 Address ................ �,��d-.• ...G-,. ................City ..._ ~...... ..../.:..._._. Contractor's Name . License - Phone ................ L ._........... .... . ....._._... .............................. Installation will server Residence)dApartment House] Commercial OTraller Court 0 Motel❑Other Number of living unitss............ Number of bedrooms Garbage Grinds .. Lot Size ..................... Water Supply: Public System and name .... .. ...... '- •f' --- .......................................Private 0 Chatacter of soil to a depth of 3 feet: Sand n S11t❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ ' Hardpan ❑ Adobe❑ Fill Material ............If yes,type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I I SEPTIC TANK# ] Size*,,*,,*,,*....*.........-**...... Liquid Depth ........................... Capacity .................... Type .................... Material...................... No. Compartments •---••----.. ........ I Distance -to nearest; Well .......Foundation . Prop. Line LEACHING LINE [ ) No. of lines ........................ Length of each line............................ Total length ............................N 6 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ f Distance to.nearesti Well ........................ Foundation ........................ Property Line ........................41, SEEPAGE PIT [ D Depth ... . stock Filled Yes No (3 . ............. ... Diameter ................ Number ................. .......... )Nater Table Depth ................................................Rock Size .................... ......... Cf' Distance to nearest: Well ........................................Foundation ------ ............. Prop. Line ..........-............. 3- REPAIR/ADDITION IPrev. Sanitotlon Permit 9ll ....................... Date ..................................) m y Septic Tank )Specify Requirements) ....................... .... . . ..- .�- .- r r .......s�T.... Disal Field (Spedfy Requirements) •- -_-• --- ................................ ......................... ---------- ---------------•- ---------•--I...... .......................... ._..............-•---...............----- -----' (Draw existing and required addition on reverse side). - I hereby certify that I have prepared this application and that the work will be don* In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hem* owner or licen- sed agents signature certifies the following: 4 . "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 beta a subject to Workm 's Compensation taw of California signed .. ..... ... .... .......... .. _ ..... ...... ----- .................. Owner BY . ... ........................................ ..._.... ....................................... ....•-•------.................... . „Title ................. € (if other than owner) f' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ' ...... .................................................................... DATE .....G ..-�`..��'.......: BUILDING PERMIT ISSUED .......DATE=................................. ......... ADDITIONAL.COMMENTS_- ,•._........................ ....... .......................................................................................... :_.........-. .......... ..........................._. ....._.._...---.............. ---•-•--...._.....---...• :..... ....: ....... ---•-•-----.Date ... -. .. - �- -. . Final Inspection b ....... . ......................................................................... - iH 13 2L 1-68 rev. 5I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M �,