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FOR OFFICE USE: APPLICATION FOR SANITATION,PERMIT. ........................J � a 7 72- Permit .. (Complete In Trlptieatel f � Permit No.' - Date Issued '! This permit Expires 1 Year It:ratn 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 compliance-with County Ordinance No. 549 and-existing Rules and Regulations:. ,J .............CENSUS TRACT .......................... JOB ADDRESS/LOCATION ..... V0-._ -' G ... f/l............................ ......... �.Owner's Name :__ .... :............................:................Phone ......... . ........................ —` 72fC... ::� ,..._..... .City-....Zc" L ... •---- /r_:..f. .......................... f-- .....License .-��. .��.... Phone �� .. ....-. f Contractor's'Name ..................�a -'�..�_�.�_'��.... .....-.---• Installation will serve: Residence oApartment Houset] Commercial QTraller Court fl t '� `• -Motel-[]-Other:.......--.....'._.........�............... Number of living units:.:.-.._.. Number of bedrooms .. Garbage Grinder Lot Size .....- .... ••••••••••••••.. Water Supply: Public System and name . •-••--...... ........... ........I..................... :�:........................................Private ' Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay 0 ' Peato - Sandy Loam`o Clay Loam Adobe Fill Material ........... If ye's,type ..................•••••• . ' Hardpan [] ❑ ,a ;O (Plot plan,:showing._size. of lot, location of system in relation to wells, buildd g; etc. must be plated on. .-- side: NEW INSTALLATION: (No`septic tank or seepage, it•permitted if public sewer is ovailable,wi-thin 200 feet,);; PACKAGE TREATMENT [ SEPTIC TANK Size..... �`r-••-�-�•7"-.......-•---•............ Liquid Depth --._�........... ] Capacity Type .. ... Material.._.��'x No. Compartments ..Z-./.. =: . M 1v ' ._ Distance. to nearest Well .r ._Foundation �O rop:Line, ••- P LEACHING LINE No.iof Lines -. _. Length of each Zine..---- .7--- Total Length ......:...... 7/ . 'D' Bax ..........?: Type Filter Material ...R •-Depth .Filter Material .....f............�, i ;, ..sf" Distance to nearest; Well ......:�i. .-..-----••• Foundation 9 /�?. !'.... Property Line .fir.. `....... - ` SEEPAGE PIT [ 1 Depth . Diameter ------- ........ Number ........... Rock Filled Yes ❑ No Q r. Water Table Depth .............-------------- Rock Size ................... Distance to nearest: Well ..foundation .. Prop. Line :...••.•........•••••• _ -................................ ........... REPAIR/ADDITION(Prev. Sanitation Permit W._ Date ....._..._:..... y { Septic Tank (Specify Requirements) / :......... ......-•--------•----....------••-----•................................... _ L -. r Disposal Field (Specify ,Requirements) --------------------------------..._._................................ ........................................................... k } ` 4 ....................... .. --------------"------...____�..---..•---_...._.__ ._.__.---..._.----------- - k (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work milli be done In accordanu with San Joaquin P County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or llcen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall net ernplor.any person in such manner as to becoine subject to Workman's Compensation laws of Califeirnin.'1_ Signed ---•••--• Owner n _ ' ............ 7i#le - (If othe t an owner] - FOR DEPART USE NLY '------, DATE APPLICATION ..I-.IL?-7.� .. -.....: ACCEPTED BY -- -----: - ---- ---- ... _. ... BUILDING PERMIT ISSUED -------- ------ -- - -• •-•------- --_.... ----•-•.._......... ...._..---DATE ._.-- ..--- ..... .... ADDITIONAL COMMENTS .---- ........................ ------•---•-•---- ------- ----- ------------- -------•----• I---------------••----------.............. ------ -- �_....._...__... I._.... ---------- --- -------------------- ------------- .,. _ Date .... _ - ...-- Final Inspection by: . -- - - -- -=t- - ..:....`__�: ------• J .......... ... . i EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL' HEA1,T TiZICT 8/74 3M