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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •7 sy .............................. Permit No.74.-..1.Z (Complete in Triplicate) ..........I.......................•. .................... r �- ...................................................•.•... This Permit Expires 1 Year from Doh 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 complionnJce w�tthunty Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESS/LOCA ION2...L ' '1............................... CENSUS TRACT .......................... Owner's Nam .._.Q...... � 6 - ......Phone -------•------••- -••............... Address ► 1 ....................... City .. . .........--...------..----------------------------- Contractor's Name r- ..........-------------------------------------------------------License # ........ ............... Phone ..................... -------- Installation will serve: Residence©Apartment House f] Commercial❑Trailer west# Motel ❑Other............................................ Number of living units:_l.__-_-- Number of bedrooms ..2:......Garbage Grinder ............ Lot Size .�'.Q.............I......................� Water Supply: Public System and name ..................................._-•---......------..._....----.................------............._......Pr€vate Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam,n Hardpan❑ AdobeZ Fill Mater(al ............If yes,type............... ............ (an showing [Piot p owing srze a# lot, location of system in relation to wells, buildings, etc. must be plated on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { J SEPTIC TANK Size-47+Z_v_-..t'r................... Liquid Depth _.. .may.............. Capacity M-9.0.....__ Typ ...A�-- Material...��.�"........... No. Compartments .,2- ------------ - 6 I Distance to nearest: Well --J .1..4:.V....._._....Founndation ,fid............... Prop. Line .. . �...._.... LEACHING LINE Pq No. of Lines , ................. Length of each line-----flor ............. Total Length . FAa 'D' Box �-_-.- Type Fitter Material :,�✓1...�'.____..Depth Filter Material .._. .............•.............. ... . Distance to nearest: Well ..........$A— Foundation ...l..0............... Property Line AI.D .. ............_.. SEEPAGE PIT [ Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 WaterTable Depth .................................---------------Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ....... Date .......... ...... SepticTank (Specify Requirements) ................... ..............................................................w............-..............I............................ 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 Joaqvin 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _.. Owner BY ------------- ------------------------------ --•--- ••-•----._. itle -------------------- ---- (If other than owners FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY /� ,/ DATE 17.'7Gr•-.----------------- ------------ err f .�1'+� .....-------- --- .. BUILDINGPERMIT ISSUED --------------•-------•- ------------------------ ------------------------....--•.............................................DATE ----- ----------------------.... ADDITIONAL COMMENTS -----•-•----•-- ...................... ---------•-••------------------•--•----•--••-•-•---._-..._..-.... ------ ........................................................ -••--------------------•---•-----•-••- - .... --------.... . ins Inspection by: .._-•--- - /,t ---..---.....................Date _ ._'....__.r. .... _.------..._._-._.__ I 01 13 21a Rev• `) SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M f i