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FOR QFFICE USE: ` APPLICATION FOR SANITATION PERMIT .......... ............................................ 'Complete In TriplieaHl Permit.No. ._ ..............................................:.......... This Permit Expires 1 Year From Dale issued Date Issued .. '?. .. c 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: ct�I 108 ADDRESS/LOCATiV�- Address �.6.... ... ... . ......................................................................CENSUS TRACT .......................... Owner's Name .......... Phone /�'. .!?�j- ................-..-...... L. ?�... _�i�p.•..... .................lcity ... - .... _ _...................................................... Contractor's Name -----•.......... �' �!' ... -- .s N��. .................... ..License #?- `f'3.'� ..... Phone . - �'.�.Z...... Installation will serve: Residence IgApartment House]_Commercla!0Tratler Court �] Motel[3 Other--- :........................... Number of living units'..- !I- .-Number� o -bedrooms bedrooms ....... .Ga is a Grinder ........... -Lot Slice .., d�. ��.................. 71 Water Supply: Public System and name ........__ ... " -- -- ........ a .Private Q Character of soil to a depth of 3 feet ...Saeid .-�..Sllt ..... :. .......N.......................................... ..�. .................................. E) p Cloy ❑ heat© Sandy Loam❑ Clay Loam Q Hardpan o t . Adobe gi Fill Material ...... If Yes,type,_ ............ .......:.... f 1PIot 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# ] Size...................... .. . ............ Ugvld Depth ................... . .. Capacity -•-•--......--•.... Type ............... . .. Material.... - '...._._..:... No. Compartments ..:................. 04 Distance.to nearest: Well ....................................Foundation ...................... Pro Line..........--•---......6 ng p. LEACHING LINE [ ] f Lines .............i ... Li4th of�each line.......� • h . P :....... •-----.............. Total Length ....__..._ ................. m 'D' Box ............ Type'Filter Material ......................Depth filter Material ................................... Distance to nearest: Well ........................ Foundation ....................... Property Line .....................:.. SEEPAGE PIT [ ) Depth r Diameter . Number ... .............. Rock Filled Yes ❑ No C3 Water Table Depth . : ..........................................Rocks Size ................................ Distance to nearest: Well =.................::.............. .Foundation Prop. Line REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ +Date ........ ......................... Septic Tank (Specify Requirements).........-....-•--•--- ...... ...................... .. .......................... - Disposal Field (Specify Requirements) ._•--•. _ ls._�.. C:_ _ .......................................... ............ .. _ x_ A L..-I.. ..._._ ........ ...............•-•--............--- ....................... _ IDraw existing and required addition on roverse side) 1 hereby certify that I have prepared this application and`thatNthe work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horse owner or licen. sed agents signature certifies the following: "I certify that in the performance of the wank 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 By .... ........... -A-1 .. ' Ilf other t owner] -•--•---- - Title _....---•--. FOR DEPARTMENT USt: ONLY APPLICATION ACCEPTED BY --- -. .-•-. ---•- .-----.------ DATE ..... ... .�� - -------------- BUILDING PERMIT ISSUED ..--•- ........ DATE ---•--•-•- ---------------------------- ADDITIONAL COMMENTS ..... Qom. ...................... .............................• --- -•---•/*-------- ---------------------- ....-----•.................----.-................................................... .. ... ........•---. Final Ins ection b P y: ... Date 7 � 3 2h 1-6fI v. SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/74 3M