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FOR OFFICE USE: APPLICATION -OR SANITATION PERMIT 7e 47�1 Permit No. .............. (Complete in Triplicate) ....... :............................. ......................... Date Issued ................... --------------- This Permit Expires 1 Year from 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: JOB ADDRE LO.CATION ....ez�. L _..:. ;....~.. .... .. ........:.. CENSUS TRACT ....... ...... ::. Owner's Name .� . MJOW ........ O..r ........................ - . ..Phone. .................................... Address ._.._.. ........ .. .......................... .... City f '( ._.... ... ........................... . .................License #• . Z®!. ...... Phone n .. Contractor's Name ....--. - -;�• -.r,.�G......... ............:........ .: Installation will serve: Residence Apartment House Commercial ❑Trailer,Court 0 � Number of .li.ving units:............ Number of bedrooms ..:_ Garbage Grinder --------_-.. lot Size ._ .... - Mo#el Other _ ... l Water Supply:.Public System and name --------------------------------------------------------------- ----------•- ----•-- ..................,...Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ -Peat❑ Sandy Loam ❑ Clay Loam Hardpan C❑ Adobe-❑ Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed .on reverse sldeLl) NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK p4 Sixe..- : ~ _.~'....___.._.'liquid Depth ..4 ___ .......... )" Ca acit .._ Type No. Com artments pS ...._. � p Y Yp Material_. _�--�'xi- p. .........O Distance to nearest. Well . .__.._Foundation ___ Prop. Line — LEACHING LINE J(] No. of Lines :___.___'!�L_--___-_ g i..D.._. g _._ Len th of each line.._.___.... ....__ Total Length'-'. .............. � er.� �Tal ,�✓?�Dep Depth Mated Distance to nearest: - --- atMaterial �Ln� .___.�4 � y" ' -Rock Filled Yes N.o.,__,� SEEPAGE PIT � Depth -.��---�-_-... Diameter _j:.�'•----'Number :-----�.�.------ ------ - .. .. : - � , Water Table Depth f.+ - ,�Rock-Size 1-•� - ----•---•---- � � -- In Distance to nearest: Well/.".. ..............::.........:..Foundation/40.'..._..._....... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit!# ..................... Date __:............................... ) � Septic Tank (Specify Requirements) . 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-.rhe-done in accordance with San Joaquin, County Ordinances, State Laws, and Rules and Regulations of the San Joaquin' Locai'Health District. Horne owner or €icer 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!&Compensation laws of California." Signed --- . Owner .: By •---... Title ....................................................................... If othe than owner) FOR DEPARTMI T USE ONLY -. .-.-----•---------------------------- DATE ..Ld..'" � •. APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ...................................... --•-•-••--••---•• ........................ ..............DATE ' ADDITIONAL COMMENTS .......................................•-•------ ---"""--------.--------------- .........................................................• • --------••----------•••- ------.........-----............. ..................................... .. . . . .... .................................... -- :...........:................•-............------------------------------------------ .. . FinalInspection by: _.........�o. --•--=-------------•-----••---....... -----......--•-----........-----••-•---.Date . .Q�. . Fin SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'6$'Rev. 5M 7/72 3 �K