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FOR OFFICE USE: APPLiCATION FOR SANITATION PERMIT Permit No.. }- (Complete in Triplicate) ---------- ----- i ----------------------------------------------- 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 install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �, q �SU4Ld 8�c1 � JOB ADDRESS/LOCATION -------�-.5 _7�L--._-___-.--S__---_fJt�_ _ �------- ---- NSUS TRACT __ .'_ Owner's Name --------e -------- -- -------------------------------------------------------------------------------Phone _ $J`_-_---- Address ------ -------5'------ -- City � C� y ---- Contractor's Name ----C-2c ---------------------------License # Phone ---i1 3PZS - q_ Installation will serve: Residence PaApartment House[] Commercial❑Trailer Court 0 Motel ❑Other -----------------------------------•-------- Number of living units:.----V Number of bedrooms __2-----Gorba�qe Grinder ----1------ Lot Size _-��_� x --- Water Supply: Public System and name ------------------------- --------------------------•--••----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam it Hardpan a Adobe Fill Material 11i---__ If yes,type ----1 ------__ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTICTANK.X Size__1 _-2_hc.______ _ ._-------- Liquid Depth __ _____________ Capacity _/em Type ____________________ Material_- r No. Compartments ------;?�n--__------ h Distance to nearest: Wellr____Foundation -----10--_-__.___.Prop. Line -_-0,_-1V------ r 0 LEACHING LINE No. of Lines -- -g-----_--__-- Length of each line-.------ 740---------- Total Length ------/gip-_------__-_ D' Box _�--.----.- Type Filter Material � �r �--�_-�--�-�------*------- ' yp -��___-____Depth Filter Material .____/_ �^� Distance to nearest: Well _.101?''_`/_ ___ Foundation _--_ �----_--.-_-- Property Line ---204--40e PIT J Depth ----/3---------- Diameter _-T. --- Number --------- 1—_�:--__-_-- Rock Filled Yes 'C2t_ No ❑ Water Table Depth --------------- l �r -i------+--------------------Rock Size --------l- / Distance to nearest: Well ------1S-0-----------------------Foundation -----N-------- Prop. Line __-_-_ REPAIRJADDITION(Prev. Sanitation Permit# -------- ------- ------------------------- Date ----------------------------------) Septic Tank {Specify Requirements) ------------------------- --------------------------- ------------------------__---------------------------- 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 San 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 issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----------------------------------------- -------------------------------- Owner I BY Title --------------------------------------------- -------- (if other than owne )r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ �` �------------------------------------------------------------------------. DATE - `- --~ �� ---- i BUILDING PERMIT ISSUED ----------------- -------DATE ------------------------------------- ADDITIONAL --------------------------------- -ADDITIONAL COMMENTS ----- ----------------------------------------------------------------------- ------- ---- - -------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------------- ------ --------------------------------------------------------------------- ---------------------------------- = - ----------- - -- ---- ------------ ------------------------------ ------------ -------- ---- - ---------- --------------------------- --- pff _ J Final Inson by: SAN JOAQUIN LOCAL . f E. H. 9 1-'68 Rev. 5M