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FDR OFFICE USE: APPLICATION FOR SANITATION, P RNIIT _M ...............:.... ................................ Permit No. .... ._.-- (Complete in Triplicate) .................... ..................... Date Issued �D� ._:� • ------I—----------- This Permit Expires II 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: ..xA....... -- __..._.CENSUS ... ....... . ..... CENSUS TRACT ............. JOB ADDRESS/LOC ION .�. ....��.� -�---�-�.....4,a.... . �� . Owner's Name �f- .................. ............Phone Address � .. . -�� City _--------_.................... Contractor's Name ..... .� ....� �----- 4 License # !0-�� .. Phone .............................. I Installation will serve: Residence Apartment House,❑ Commercial ❑Trailer Court 0 Motel ❑ Other ....... Number of living units:.......... Number of bedrooms ._;�-------Garbage Grinder ............ Lot Size .....--.6.- _... --- . .. •___......... w Water Supply: Public System and name . _:. ----------------------- ----- --- -----: ................ ...........................Private Character of soil to a depth of 3 feet: Sand❑ Silt E], Ciay [ Peat❑ Sandy Loam ❑ Clay Loam C3 W Hardpan ❑ 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 side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT ( ] SEPTIC TANK Siz e /�... `., v- -- •-- Liquid Depth .. -... -- f r n - .. ... .. No. Com Capacity 1 bO.O Type g - Material.( -f+r? --. Compartments ----•-•-, r t .Foundation .... Pra Line ...�-------- -- Distance to nearest: Weil . .G_�,.t��-------------- �..�-......---- p• LEACHING LINE �j _ N;: of Lines Length of each line ... .. ............ Total Length Alp-49.............. 'D' Box Type Filter Material --.` ...A......Depth Filter. Material _._...f ................�------------- Distance to nearest: Well .....�.aQ..�...�. Foundation /0..'........_ Property Line r .... ...........- SEEPAGE PIT { ] Depth . - Diameter Number ........�.............._ Rock Filled Yes No C Water Table Depth .... .v. Rock Size I..~.X ..-� Distance to nearest: Well ......... .. �.. ...............Found,ation _'--- J.-r..... Prop. Line .........-............ i fREPAIR/ADDITION(Prev. Sanitation Permit# -------- --•------------ •...... ...... Date ....................... Septic Tank (Specify Requirements) .... ----------- ----------------•----•- ------------- ------------------------------------- Disposal -----------------.._...-------Disposal Field (Specify Requirements( ------ -- -- :r....:......... . • . .......... ............. . .._....--------- ..... .. - _ ----- -------- -------- . ._....----------- •...... ------ ........ ... .. ........ .... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. I` sed agents signature certifies the following: E "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 rk an*s Compensation laws of California." Signed .... . ..................... ...---- ..... ----- --------- -------- Owner r- By .... -- ------ - Title . . ..... ._.... . ............. ... .. (if other t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. DATE _. _o . - -------------- BUILDING PERMIT ISSUED ............ DATE ----- ---------------_-----........._1 ADDITIONAL COMMENTS ....lD, . ----•.... .... ....... /o. ..3- .J. .. . -- ..... ..... .....a==- t?. a .-.............. ...........................................- ------- ------ .......... .Ca. ---•-- ...... ... -----..._...........................------ -----------...--------...------•---•-- -..........J.�.: ..... . lFinal Inspection by: ............��........ .------------- --------------------• ...--------.....-------.......:...- ----.....---Date •---.....-.... -...� ..7.. . SAN JOAQUIN LOCAL HEALTH DISTRICT 4 9 I c u 13 24' ,-,An ea., r%AA 7/72 3__