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rnux Wrtg..e u --r--rt— t -79 ...................................................... APPLICATION FOR SANITATION PERMIT (Complete In Triplicate? Permit No. .......................................... Date Issued .7-10' ........................................................... This Permit Expires t Year From Data 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 ADDRESS/LOCA TI L. � .!� w"' .T J .................,.........................................CENSUS TRACT ........ ............., .. Owner's Name. ._ .... ................ g Address ................. ................ .......Phone . Contractor's Flame .lh-t �r ..; ......_....Ocense # . ..Q. � - �� f _. ......................... Phone Installation will serve: Residence artment House Commercial❑Troller Court JJ { i Motel a Other . - ct' Number of living unitss_ :----Number-of.-bedroorrs,--..Garbage Grinder Lot Site ..._......................................... Water Supply: Public System and name ........................r........ .................... ........ ..... .................................Private Character of soil to a depth of 3 feet: Sand❑ Silt[3 Clay ❑ Peat❑ Sandy Loam C3 day Loam ❑ $ Hardpan❑ Adobe❑ Fill M"aterial ............if yes,type............... ...... ..... p g- - , (Plot ion, sh�awinsizeof lotlocation of system In relation b' wells,.-buildings;etr'must'be pp an reverse side.} ' ' ter. t:�� '� ._.--�--�• _ NEW INSTALLATIONF Wo septic tank-or seepagefpit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { } SEPTIC TANK f ] ( Size...... to �,�- liquid- Depth `- Capatity�. ,�P�a =x"'`ype - Material........ ......... No Compartments .�Z ._........0 .._ Dis nonce to nearest: Well a4ta...... ..Faun dation -A� .._ Pro tine .. LEACHING LINE . Ai j�, ,.�. :_ : �-l� Na. of Urea_.... Eength of each line. . Total Length. . #. - I ... ....... -- ---..... ... 'D'�-Box Filterwrial f �, !Mal -2110 �paera ............................... ..... ... • , .,'.Distance to nearest: Well .'..................... Foundation ..._.................... Property Line .... ........... SEEPAGE PIT R [ ) Depth .................... Diameter ..... Number .....- Rock Filled Yes ❑ No e---........ • Water Table Depth __._.�._��.....................................ltack`-siz �. Distance to nearest: Well�; ...........::foundation f Prop. Eine .. c REPAIR/ADDITION(Prev. Sanitation.Permit Septic Tank(Specify Requirements) ...... .......... -----•--.a....._............................... Date ..._......._.�........... Disposal Field (Specify Requirements) ........._ ~!.....................................•-------.... .... ... . ...... ,.........._. .. ........... i ° .... ..._............ ... ••-.......ti .................................................._.. .. ... ...... .... ........... " .......................................................{..... ......----•- ...._......... ....----•-•-•------....--••--•--.....---......---...................:.......... Draw existing and required addition oh reverse sidel av I hereby certify that I he prepared this application and that the w�prk will be done In accordance with Sart Joaquin County Ordinances, State Laws, and Rules and•Regulations of the San'Joaquin Local Health District. Home owner or Itcen- sed agents signMure-certifies-the-followinge'�- '_' + . I certify that In the performance of the work for whii:h this permit Is fi sued,-I-shall,p_ot employ any person in such manner as to become subject to orkma 's Compensation laws of Callfarnla°' IE Signed ., . :...... Owner By ....................................................l ......................... .................... . .. litle ...........:........................_............ ......... ..--- (if other than owned I i FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY ............................ ............. DATE.. —...1..: ....?...:-- BUILDING PERMIT ISSUED ... . ......;. ..... ........... s,.. . . ADDITIO L CO NTS. sfc.P.. -. ....... DATE ..... ..: ..... .... ................ inn Inspe pan by: .......... ....Date . ...,1.. .--77............. ..... EH 13 2h .1-68 Rev. q[ SAN JOAQUIN LOCA! HEALTH DISTRICT $/7h 3M