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ry � �rvSe �rrS�x use APPLICATION FOR SANITATION PERMIT ...................................................... (Complete in Trlpflcata) Permit No. .. ... ............. ..........:.. ..... ..• I ... .......I........`. Date Issued..... This Permit Expires 1 Year From Date Issued � `.�.7 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 Mules and Regulatlons, JOB ADDRESS/LOCATION ..��..8 ,�}�.. ... i .....................CENSUS TRACT Owners Name . -f � .... ..........................I.....................................Phone .Y,�K7./!._P11 ....... Address .: � Z- .. .. City .. - : .... ... .. Contrador s Name ..- � ,--•- -- .................... :::............License # Phone .. Installation will serves a Bence�artment House[] Commercial ❑Tralli ur Motel❑Other............................................ Nurnbe' of living units:.._... ..._,Number of bedrooms _...:_Garbage Grinder --_____-__:- Lot Size .......................................n..... Water Supply, Public System and name ................................... ..Private er li Character of soil to a depth of 3 feet: Sand❑ `Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ Hardpan Adobe❑ Fill Material ............If yes,tyle ............... ............ s (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on' reverse side.). 1 NEW INSTALLATIONS 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,} ; PACKAGE: TREATMENT ( ] {SEPTI C-TANK.f- ' z*�--•----Siz ...................... q p f 4 -----------------------•------ Liquid Depth .......................... Capacity�.� _.. pe _ _______ _____ Material--_-____:_-________-__ No. Compartments .... ............ Distance to.-nearest-.--We a-- f ......................Founda�an _._�f.-_________-- Prop. Line . ....1....._..... LEACHING LINE I ) ,,-No of lines .- ,1 .. length of each it lam Total Length+ . 1 ......... ..j.. � # x'D' Box _...__._ Type Filter Material . ..Depth F11ter Material .�.�.f� ................................� • Distance toneacests Wet) ........................ Foundation .......:.-----••-•---... Property Lina :....-...........•.-__-_ SEEPAGE PIT I D • Depth _ - - _- - -_._. Diameter ___ ------- Number ................... ...... Rock Filled Yee ❑ No Q Water Table Depth - •----•-•................................Rock Size ................................. ; l Distance to nearest:Well .._....Foundation .. Prop.-Lina REPAIR/ADDITION(Prev. Sanitation Permit# ..................................... .. Date ..................................) Septic Tank (Specify Requirements) .... v..... _..................... ._........_............. .................................... ...._.._._..w .._.... . Disposal Field (Specify Requirements)..•••..............A..._✓.......----...._..._...-'----------- -•---...--•--- •--•-•........................................F.... ................................ F -------=-=------'•-••--•--•-_------.-._...._.. .. -s ' z,....._._,.:............:............._...................•._....... . ........................................... ........... ........... .......... ...._..... ......•••--........ . .............. (Draw existing and required addition on reverse side! 1 hereby-certlfy that I have prepared this applicallon'and that the works wilt be done In accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or 11"n- sed agents signature certifies the following: ; ' i. "I certify.that in the perfarmai2ce of,the work for which Ihis-permit Is Issued, I shall not employ any parson in such manner as to-become subject to Workman's Pomp4insd6n. laves'of Califontla."_ —'Signed- ........................................ Owner By .. ..... .................................. .._ itle ..............................._._..........:.......::.................. (if other than owner( + FOk DIEFMTMENT U E ONLY APPLICATION ACCEPTED BY,.._...:._... ... ........_......._.. .................... BUILDING PERMIT ISSUED ................................ . . _:•.• .. •-------------------------- --------------•-----...._....----•--...---'--- ...---- .-DATE ....._.............:---• ADDITIONAL COMMENTS •-------... .................vti ---......--•-•-.............. .... ..... ,... . Final Inspection by ........................Date _. ..._....... .._`�....__ EH 13 2h 1`68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 314