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FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT IComplete in Triplicate, Permit No. .-_._................ This,Permit Expires 1 Year From Date Issued Date Issued ............ . . . f f 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 ADDRirSS/LDCATiON ._...�.-. i i . .......- ........".................CENSUS TRACT ......................._.. Owner's Name _.. _1............. .. ............... ho ne ..........,........... _..... ...._.. Address -----...... .. ...4zvt,........ ...... .......................... Contractor's Name .----- __-. .. •- --.` License # .� .�'. ... Phone . Installation will serve: Reside Apartment House 0.Commercial [QTrailer Court ❑ Motel []Other ..•...............:. Number of living units:------ Number of bedrooms ...3_:_Ga'rbage Grinder .._._....... Lot Size .... ........ . ... Water Supply: Public System and name .... ........... - ••-_... .._....--....- ....Private Character of soil to a depth of 3 feet: Sand Silt Clay ❑ Peat Q Sandy Loam 0 Clay Loam ❑ Hardpan Adobe Fill Material yes,type` ❑ ••---._..... if es a---•........... ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: i (No septic tonic or seepage7pit••permitted tf pul,lit sewer is available within 200 feet,) PACKAGE TREATMENT ` [ I SEPTIC TANK{o] Size-�.1,�._�_.`-j..._..it`-- .._............ liquid Depth --..........� Capacity 9-0:P.-?at Type Oo .... N . Compaments ,2 ..............90 Distance.to nearest: Well . :Foundation ...................... Prop. Line ...:.................. LEACHING LINE.. No. of Lines ......2............. Length of each line............ ......�_.... Total Length ��.�.o f- -_•---.� 'D' Box .. ..�__--- T .r . 1 ype Filter Material .... .....__.}Depth_Filter Material...._ ........:... ................ D .. __.1_6134114 SEEPAGE PIT istance to nearest: Well ........_. ...kFoundotion ..__ Property Line .....5. 4. D ........� .r. [ epth - _.J. _. � Number -3- -...._ Diameter -------- Rock Filled Yes No C j Water Table depth .. �_:.._ � �o .. Rack Size . ... 7 Distance to nearest: Well ......./4?��---------------Foundation ---/40 -- Prop. Line ."- .. REPAIR/ADDITION(Prev. Sanitation Permit# ................................ Date ..............-------- --------) t `Septic Tank (Specify Requirements). .-"................. ---------.._..---................... = ..._ Disposal Field (Specify' Requirements) ---------------------------„------------------------------------------------------- ------------------- �J - ---•----------------- --------------- ---------•-•-----------------------• -----"""---•...__.... ........................................... I(Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State,Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- sed 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 Workman's i Com ensu p Ion laws of California... Signed ------------- -- Owner By _�---------- ------- ------•. .. - Title (if other than-owner) - FFOOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - £_ y ”- !TATE .. �... 75 ILDING PERMIT ISSUED --- - -------------- -------------DATE .................................. _._.__. ADDITIONAL COMMENTS . __________ ........... final Inspection by: ............... •------- _ .............Date -- -- . Ell �3 2b 1-68 aev• 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8 7!i 3M