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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {:...� ......'" :..,:.....;............. . .�t-.tCotnplefe.in.Tri licatel Permit NaZS ........... ....... ............................................ .. This Permit Expires I Year From Date issued Date Issued,l�::a:�:2J' 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.gounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..`its. -�Z3 ..-.51 S TRACT ...... .. Owner's Name SY � C .........�.._ -------..... .Phone:.:! -•-- g Address City G3�1''L �...................... ........ .......... ............................................................... Contractor's Name .•...License # ......................... Phone ...... Installation will serve: Residence 0 Apartment House f] Commercial Trailer Court 0 Motel ❑Other . Number of living units.-_6". . Number of bedrooms Garbage Grinder Lot Size '..,v . ........ Water Supply: Public System and name ........................................................._....._..,.............. .............. (]. Character of soil too depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat[3 Sandy Loam {] Clay Loam Hardpan❑ Adobe Fill Miaterial ............if yes.type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.)- NEW INSTALLATION: (No septic tank or seepage pitlpe i1tted if public sewer is available within 200 feet,). PACKAGE TREATMENT .44—SEPTIC TANK -j- ': .. Liquid De Capacity --- No. Compartments ...................... by -------------------- Type --------•-------. Material---...---....:.... Distance.to nearest: F Well ....................::.............. ......Foundation . Prop. line LEACHING LINE No. of Lines:.©)AV_- ----- Length of ea �llne O ..•- _ . --- Total Length .. ... a 'D' Box ----__.-.. Type filter M ter€"• T : p ' ter Materia ................. . Distance to nearest: WellFoundaton _ ...... lroe Line y__................. ..` Fs irtY ,SEEPAGE PIT - Depth -------------------- Diameter ............_e.. Number -------------- ........ Rock Filled Yes 0 No {]_ Water Table Depth Rock Size v Distance to nearest: Well .... ................._.......Foundation ................ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# - Date ,[ Septic Tank (Specify Requirements) .................................................••-----------•-•----- - ............ --................ Disposal Field (Specify Requirements) 4 ---------------------------------- t L r.1 ---------------- ---------- --- ---------------...._---_--_.•-.----.-..._-__.s:.......:..................._._..................._......_.....' (Draw existing and required addition on reverse side) i I hereby certify that l.have prepared this application and #ha#the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of #heESan Joaquin Local NOW&District. Home_ owner or Iicen- 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 bec a sublect�a Work an's Compensation laws:of Colifornlo:" IJ)�' Signe _ :_._... --------------- ....................... ----- Owner BY -... - ----------------------------------------------- .......... Title ..... ............ ............................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ^ - DATE..., . ..-: �_/. ......... BUILDING PERMIT ISSUED _ _------------------- 1/._....__... ............................DATE _---- .............. ---••--- ADDITIONAL COMMENTS .................................... •---.--_------ 11... ------- -------------------------------------------------................................................. ;' .................. ............................................................... --- ---... . - .... ---------- • - -• --- ------ Final Inspection by: - -------------------- --- ---- ---• -------=-- ---- -- - .- Date ._... EH 13 24 1-68- Rev. � �'.. ._ SAN JOA LOCAL ALTH DISTRICT 8/74 3M