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FDR OFFICE USE: ` APPLICATION FOR .5ANITATION PERMIT Permit No. 74� S`S^ (Complete in Triplicate) ..... ..l ._.._._. ..:.................................................... ......................................................... :� This Permit Expires f Year From Date Issued Date Issued 'f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ii described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._.v... .. ..__✓� r� !-1,...................:.............CENSUS TRACT --------------- . �.. _. Owner's Name .... . . ... -------------------------------------------------------- --------Phone'.................................... Address -----------•---- ...... ..................................' ......................•-.. City .._._......-•---.... ---->.............. Contractor's Name ---•----•S l ----------- -•----.......License # ......................... Phone .............................. Installation will serve: `Residence Apartment House 0 Commercial ❑Trailer Court ❑Ot,her.----........••------•••••g----------------- Number of livingunits:..._ NumberQofl.bedrooms_.�.....=.Garbo e Grinder der Lot Size Water Supply: Public System and name ..... - --- _ ..... _______._. ........................: 0 ••--------_-----._...---Private -�- Character of soil to a depth of 3 feet: Sand! gSilfi❑—CiQy ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑;.:FiI Material ------------ If yes,type -----------------------•_-•- i (Piot 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 seeppee pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK . Size- -----------------------•--•_----._.. ....... Liquid Depth .......................... Capacity 1 ..._...... Typ !.24 .. 0 Material--6fF-"-_`_.��.�.�T� No. Compartments ...:............. .__...� ._ Foundation ..A:QI....._...... Prop. Line O Distance to nearest- Well Q._.f��___-•.- -•-•.................. LEACWG+f •E ( No, of Lines ..........:............. Length of :each line.-.---------.----.---.------ Total Length ../Q. `KQ1_..r1 I'Ci` ¢� D' Box Type Filter MaterialG ��!'..�Depth Filter Material / ................ 1.-..-- Distance to'nearest: Well ..4 -2(........ Foundation 6..... 1or Property Line ........................ LA .............. SEEPAGE PIT [ Depth _..._...:._.._:..:... Diameter ........._.t- Number„............................. Rock Filled Yes 0 No Q I Water Table Depth-.---------- .........................-........Rock Size ................................ Distance to nearest: Well ........................... ....___.....Foundation .................... Prop. Line .................... f { 'F �. REPAIR/ADDITION(Prev. Sanitation', �# ---------------------------------=--------- Date _........_.....---•.--.•----.•_-..) Septic Tank (Specify Requirements) ” --` _..... - ,i Disposal Field (Specify Requirements) .................: ---------------------•---------------••-----------------------------------------------------•-••----....._............---..._......._..._. ............................................ -------------•--• -----------•--•------•- ---•---•- ---------------------------.---------------------------------------.---- ;(Draw existing and required addition on reverse side) th I hereby certify that I have prepared this application and that e 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- 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 Compensation laws of California." Signed ----------------------------------- F..............._..:.:.................................... Owner FBy ....... --------- ---------- ............................... .Title .....----........_ (If other than own`e`r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... 1---- -••........................................ DATE .....5_..`:�................ ...... BUILDING PERMIT ISSUED ....... ... .....' ' - DTE .- ---- .... -- AQDITIONAL COMMENT ....... ---_...-- -- ------ ..._..-• ............ --------- ---- - -- '_ ............................... • s ................ FinalInspection by: .............��.. ..:. . ----------------------- ....................................:.......Date ...... ".r� '..... SAN.JOAQUIN LOCAL HEALTH DISTRICT r is 13 241.-Aq P.,, 5KA 7/77 3 M i