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FOR-OFFICE USE: APPLICATION FOR SANITATION PERMIT _... _� .................................... (Cotnpleta In Tdplkatel Permit No. .76.:.'.: x , Date Issued :� .7.. .. This Permit Expires t-Year From Date Issued, R Application is hereby made to the San .lo quin'Local Health District'for .a permit to construct and install the work hefeirn described. This application is made in -compliance with County Ordinance No. 549 and existing Rules and Regulations: Job ADDRESS/LOCA N<., .�`'1at. .:... ... . ..•...............:.............................................CENSUS TRACE ..... ..!.. Owner's Name .._ ._ ' e _�_ � _ ....----- • .................• ......Phone ................. ......... . . Address Z. city Contractor's Name z-?r.ru -:. .... h...............:.....................License#44F3.E?:�Phone ............... - Installation will serve: Residence[Q Apartment Houseo Commercial OTrailer Court 0 Motel ❑Other Number of living units:__.f_..`.. Number of bedrooms f Cmrbage'Grinder _:.._._:...: Lot Size ..- - ..--..--- --•-•- Water Supply; Public System and name ............:... ---- -_---........•__.-____....._.:.--_ ------------------------------------------Private Character of soil to a depth of 3 feet: Sand t7 : Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam-o Hardpan W Adobe'o Fill Material ...._._._... If yes, ... . .. . ........... type . .. ... - �- RPlot'plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slcle.I NEW INSTALLATION: (No septic tank or see ge pit permitted 'if yc c sewer is available within 200 feet,l t , PACKAGE-,TREATMENT { ]. SEPTIC TAMC Size. ! ��..��`_ Liquid Depth -•-- ........... .....---• Ca a 3 r p city.:--x �.� Type - . .Material....... No. Compartments .. �::......:.. , _ Esta rice to nearest. WellQ. .. .Foundation ._...l�� Prop. Line ..........zt LEACHING LINE C s No. of Lines -.:.....'fir:.....:. Length of each line------ Total Length ... ..e` � .. ..... U1 'D' Box .....1._.:' Typs Filter-Material _..•-- ?..!_Depth Filter Material .�1 _.`. -.... rF. Distance to nearest. Well � Foundation 1.-_-_- f Properly Line ` I y.r, .. 1_ 4 SEEPAGE PIT (�]/ " Depth ..-._- _ ,._.. Diameter .. ...... Number .......�........ .... Rock Filled Yes No 00 x. Water Table Depth'.,:_ =�" - a::� --=..Rock Siie X-r5.......... D s - fi Distance to nearest. Well l Q .. ...Foundatiori �p: .. ... Prop Line --->..............., a REPAIR/ADDITIONIPrev. Sanitation Permit' ---• -------------------------------------- Date ----------=--.---_-..-.. . ....1.,. N Septic Tank (Specify.Requirements),. ................ .................----•----......... ---....._ •-••----_._..---------_........... :. - 4 r Disposal Field (Specify Requiremeitits�'� = ` ---- •----••--•------------------ •--.... ..----.......----------- l ..._..._•___•..:............................................•_.__.....__•____................_._..._._--------...--------------.._..:.--._......-•----------•••"---•-'----------•--•--•---..----------....- ------------------------------------------_................._____--.-__._---____-_•.------------..............:............................................................................. . 4 ' (Draw existing and required addition on reverse side) 1 hereby certify.that t have prepared this application.and that ther 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 Ilcen sect agents signature certifies the following: + ' "I certify that in the performance of the work for:which'this:permit is Issued, I shall not employ any person In such manner as to become subject to Workmran's'Comperisation laws of California." + x Si ned -------------------- '--- --- - ...._ .. - --- - Owner BY --------------------------------- .. .. _._ - _ Jule .... °.... t (if other than owned. FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. � ' � :...---'-----•=----• DATE, 3 �� BUILDING PERMIT ISSUED - - DATE ............. .. ---- .. ......................... ..--- . ADDITIONALCOMMENTS .---'!-------............•----------------------------------------------------------------------------------- ----------------------- ---------- ------ ------------=------•---------....-----------------..--------- -------------------•-- ------ ------- ---...----------.._.._..............-•------ ------------------------------ Final Inspection by- ------------------ - - ---------- - Data ----- ... r;; . ... EN 13 24 1-68 Rev. 5M SAN JOAQ.UIN LOCAL HEALTH DISTRICT 8/74 3M