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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r `` Permit No. ..•... (Complete In Triplicate{ ....._. ............ .......•.......---•••.........---- _ ........................ This Permit Expires I Year From Date Issued . ..: Date Issued `:Z.74 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 Mules and Regulations: JOB ADDRESS/LOCATION .-... .. �i�,../ .... ./-r '-•-��• . ._ -- . , ........... CENSUS TRACT ......... ............. Owner's Name � .Z� � .... ,.. :... .Phone Address . .. ' - _ .................. .........................city ,P. f7 Contractor's Name ---,�.- 1 `" y .................. Ph �. ��....__ ....License #�7..�.._.,.�.�Phone Installation will serve: Residence 0 Apartment Rause 0 Commercial oTraller Court � Motel ❑Other................:...............•.......... Number of living units:...1 Number of bedrooms -. Garbage Grinder Ve- 1 Lot Size _-i�f�� Water Supply: Public System and name .... ......... .....................Private, ------•--........._..........--•------..._.....•.._....................:........ Character of soil to a depth of 3 feet: Sand❑. Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay loam ' Hardpan [I Adobe❑ Fill Material ............ if yes,. e (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NSW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) f PACKAGE,TREATMENT F ] SEPTIC TANK . .... ....... Liquid Depth ._.. ................. Capacity 4- -�Q-•--- Type Material. iii'�I es.'... No.. Compartments QQ •---s._.-.-. Distance to nearest: Well'.. � ...................Foundation... � ....._ Prop. Line ZW4`� N ........ LEACHING LINE �[�Q No. of lines ..__. .............'Length of each line.._ ... Total Length ,l_7 .�......... r ,4D' Box i/1� . Type Filter Material/.�. d- a 40bepth Filter Material f ................•- Distance to nearest: Well .......✓�----------- Foundation ......_.. Property Line ............ SEEPAGE PIT !" Depth ax' ~' Diameter p > ._--- Number _...�......•......... Rock filled Yes, [ No I❑ Water Table Depth .rif....� I. � .._Rock Size,� •^' ,�- ----- •-T•---=•`-----••-•-- -----••-•... ... ............ Distance to nearest: Well -................:Foundationf----.._ Prop. Line : r -- •a. .`.......�. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................} � Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) -------=...................... ` . (Draw existing and required addition on reverse side) i hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances; State`l`aws, 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 -- w ...---- -- - O ner --•-- -- ------------ BY ------------------------ Title - k (If at' thpi�`owner) . �. li _ FOR DEPARTMENT US>: ONLY APPLICATION ACCEPTED'-'BY ---- t7i�� DATE .. -.... .... ._ . BUILDING PERMIT ISSUED`--------------_•-- -- ..........................DATE - ADDITIONAL COMMENTS .____..._.............. ----------- -=- t •------ -----•---•-------------• ----------------------------- -------- ...................... ............................ --------------- ...... •--------------• ` ------------ :. ...............,__..........._._.,__..._.-._-.--_.______._...__...... ..__.__._.__..__.__....._. _ inalInspection J 6Y: .. ---- •- Dote ... -.� __.7-_..---- EH 13 2 - v� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M ! I �_s