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Rc MC APPLICATION ICOR SANITATION PERMIT ...........................................:'... Ito Permit In Triplicate) Permit No. .77.a.U. .............•••.................... . ......... T This Permit Expires 9 Year From Date Issued _ Date ed Application is hereby made to the San Joaquin local Health District for a permit to consfruct and Install the work herein described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulationse r JOB ADDRESS/LOCATI c� ........CENSUS TRACT Owner's Name ': -�.�.. ... .. ............................ ._ t...............................Phone �. Address S .; { ,��(ty .A65 .. Contractor's Name -•--•---_ c. ...... ..... .......... .....Y.:.: ....license # Phone r a-Z_ 225. Installation will serve: it a once Apartment House]] Commercial❑Trallor Court C] Motel 0 Other..... •------•.._.....-•-•.._.....___. � x Number of living units:.....:...... Number of bedrooms Garbage Grinder Lot Size .. _.__... •-------• ..............................r ...... L Water Supply: Public Systeia and name --- �' •--- ••--------•----•--........__-----------------------.....,..........._.......,.._-•--.........��hate _ Character of soil to a depth!of 3 feet: Sand[] _ Silt f] Gay ❑ Peat San Loom d # i Hardpan❑ Adobe❑ Fill Material.........if y s,type .........: ..----....Q fj 4Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS 4No septic tank or seepage page pit permitted if public sewer is available within 400 feet,) i PACKAGE TREATMENT { ]ik SEPTIC TANK ] �.--Materlal ... ......... ....... Liquid Depth ..:................ ... capacity -•- ...................... No. Compartments ... ' Distance to nearest.- Well ...Foundation ....... Prop Line fr LEACHING LINE { ] No of Lines Length of each line---- .................. Length la 'D' Box .1, ...... Type Filter Material ....................Depth Filter Material .................................�................. .� .. Distance to nearest: Well .. Foundation .......... Property Line SEEPAGE PIT { ] Depth Diameter Number . Rock Filled Yes'(:) No Water Table Depth .....................................:..........Rock Size --_........_. ............ P �P Distance to nearest: Well ...Foundation ....... ............ Prop. Line ...................... Ist _ � i REPAIR/ADDITION IPrev. Sanitotlon Permit ----------------------------------------------- Date ..............._. ................ I Septic Tank (Specify Requirements) .--.......o� ................................................ ' -� . . .. ....... ................ . Disposal Field {Specify Requlremeritsl ..._.._.....'. . ................................. ............................. ....-------••-•.............................•----•..--..........----........---•--.......... ......... ............................. ...........X, (Draw existing ond_required addition on reverse side) I hereby certify that I havel.prepared this application and that the work will be done M accordance with San JoegvlfZ� County Ordinances, State Laws, and Rules and.Regulallans of the San Joaquin Local Haalih Dlstdct. Home owner or llcen-`/�h sed agents signature certifies the following: "I certify that in the perfartwance of the work for which this permit is issued, I shall not employ any person In such manner as to becom subject to�Workman's Go pensatlon laws of California." Signed .... = ..................... ............... Owner By .......:.:....... :...... ....,..: tie .................................. li ............ .............------........ (If other than owner) �' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ..... ._.: -'� _...'..._:-. BUILDINGPERMIT ISSUED .:°4.............. ..................................................................................._DATE ..............................:............ ADDITIONAL COMMENTS ..'........__. . . .............. tiov. .. . .. ins......Inspection...... ......Date ........�...� - ..... W 13 � ..... 2� � 5AN JOAQUIN LOCAL HEALTH DISTRICT g/7 I�