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FOR OFFICE= USE. APPLICATION FOR !`ANITATION PERMIT .... (Complete in Tripyicatel Permit No. .Z/1411/.. .. .......... - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal( the work herein described. This ap licotion i¢ made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Baa �ry JOB ADDRESS/LOCAT;�11 C�/�P - �.�' ...CENSUS TRACT Owner's Name ........ �,h� Phone Address .............0/o-..__..�✓ _ - . tf ?lam w_. City ... � � -C<.:..........._._... Contractor's Name _....._..-.] } ................. --••-- --_-------•----..License # ......----•-•--......... Phony .............................. Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court Motel ❑Other .............:.... .........:...........:.:. Number of living units:...'-----• Number of bedrooms ..__._.Garbage Grinder ............ Lot SizeX.... ...................... Water Supply: Public System and name ................ Private M/ {� t Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ...................... r (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 [ ] SEPTIC TANK T1 j____ Si* ------------------------------------ ........ Liquid E]epth ...................... --.- Capocity/2r?0......... Type44s?. ... Material._ -,_ . No. Compartments ....L _. Distance to nearest: Wellf------ --_.•...Foundation ./J�... - _..__.. Prop. Line _. .............. +� LEACHING LINE [►]�No, of Lines ----------- � Length of each line.-----70............... Total Length .......... 'D' Box Type Filter Material54s._ ` Depth Filter Material ....___j ---......_.�............. Distance to nearest: Well .. _. --------.- Foundation .../0................ Property Line � SEEPAGE PIT [ Depth .-.-------_--_---- Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth .........Rock Size Distance to nearest: Well -•............ ,."-Foundation ................... Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit*# .......................................... -Date .................................. ! , Septic Tank (Specify Requirements) ...................1...•----•--. :.... - ---- .....................•..----.................. Disposal Field (Specify Requirements( ..-•---•----------------•----....------,--_--- --_---- ----------------------------------- ------------------------------------------------------_..... . (Draw existing and required addition on reverse side) -• -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the-Son 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 iss0ed, 1 shall not employ any person In such manner as to becomes b'ec# ;an'Work sation laws ofN�Iornia " - Signed --- . .... By ................................................... ..... (If other than owner) ..............__: Title .................................................. FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ •--... .••••-- ` ©ATE ��. ®--?. -.-•.-.•-.-.- y BUILDING PERMIT ISSUED ........................... .. . . ...._. . .._._. --.............. DATE ........................................... ADDITIONAL COMMENTS ................................ ..._. .----•---- ---------------------------............_._.I.-------- ........................ ......•.................. ....................................................................,...................... ..................................... ............... - ...............................................- Fina) Inspection by: / •--•-- ...... _ �`� --._._ .... .Date J �� -- ------ --------••-------------------------....•....... .._._....._.....-----•--Y....._....._.... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'b8 Rev. 5M 7177 3 M