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FOR OFFICE USE: APPLICATION FOR SANITATION P ......... V (Complete In Triplicate) ERMIT Penult No. . ......................... ,, .._ q This Permit Expires Z Year lrrom Date I$su • Date issued /. / ,7 .. 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 with County Ordinance No, 549 and existing Rules and Regulations: JOB ADDRESS/LOC TIQN f� - a , �........CENSUS TRACT 40 Owner's Name .._. .. . . l! .. ✓�` ....Phone Address .._... C��r i Ems. ''. ,..1.. .f._:C.__- .... .............:city .a c� ---------------- Contractor's Name _---• ..............License# • ......... phone •----•---- --__ Installation will serve: Residence[0 Apartment HouseCommercial}Trailer Court ] Motel ❑Other----------- Number of .living` , g units---.._,.... Number of bedrooms _.,�.....-Garbage Grinder . Lot Size�.---- Water Supply: Public System and name - ....._.. . _ _. . .,.�.......... _... .. ._.. .. ..............................................Private � Character of soil to a depth of S feet; Sand E] Silt Clay ❑ Peat © Sandy Loom 0 Clay 0 3Hardpan p 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 11 NEW INSTALLATION: (Na septic tank Or seepage pit permitted if public sewer is available within 2Q0 feet,! Iq PACKAGE TREATMENT [ ] SEPTIC.TANK{ j size.,................... ... -••---....--- •---..... Liquid Deli ............................ Capacity J..' _ -- Type M• l- Materialk�r Compartments- - - r No. Compo _�................. Distance. to nearest: Well �Q... ......:.Foundation Prop- Line ... •----- LEACHING LINE [ j No. of Lines ----... ...---_.. Length of each line......<;_0...._........ Total Length i'7. D' Box Type Filter Material - `r Depth Filter Material .. _--• Distance ,to nearest: Well .100...:....... Foundation ...:5— ........... Property Line �.a...._._.. SEEPAGE PIT .... ` Dep tls ...:........ ...... Diameter ... Number _-......._----........---_- Rock Filled Yes [] No ip Water Table'Depth ...................... .Rock Size ••----•........---••---• r Distance to nearest: Well ................................... ....Foundation ..................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit ` ................... Septic.Tank (Specify Requirements(! ` .... It. -1 Disposal Field (Specify Requirementsl ............... • -- .. -•--- -•-•................• :------•-•--------------•----_.... ....-•------ :.. ---••-----•-..._.•.................••-...._...--••- j . .............................•- ----- -- (Draw existing and required addition on reverse side! I hereby certify that I have prepared:.thls 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 Heal&.01strict. Nome owner or lleen. r sed agents signature certifies the following: "E certify hat in.the performance of the work for"which this permit is issued I shall not employ an as to==subject e subject to Work s Co penaation laws of California.,, p y y Person in such manner Signed _.. .. . _�.. ----- Owner By ......... - -------- E (if er #hon owner) .._------ Title •---...---- I ( FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY . BUitDING PERMIT ISS ._. ADDITIONAL MMENTS -• .._ : DATE ....._. .......... - . .. .. 1 ...,: ••------- . Final Inspection b p y: .- - ... Date ..... . � Ell 1.3 2b 1-68 Rev. 5 SAN JOAQLlIN LOCAL HEALTH DISTRICT .--- f/74 3M 0�