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FOR OFFICE USE: APPLICATION FOR SANffATION PERMIT Permit No. ��-• �---•-•�� �( (Complete in Tdp Lcob _.. .` ''. .�...1_._... . Dote Issued A,11?1_. Th[s Permit Expires 1 Year From Deft Ipued and e work rein desccricbed. hereby made application isothe San Joaquin made in compliance with Healthal Countytrict for 0 Ordinance permit and existing RulestalndthRegulations: --- .-..-.-------------•--- • - - - _ CENSUS ACT JOB ADDRESS/LOION 1 .646.1.f..... ...... --- Phone Owner's Nana --- - ...- _ .._ .--- -,,.-.-------- - -� . Address - License# J�o 3�2-- Phone .... -'----- .--- Contractor'sName Installation will serve: sidetment .._. Houser] Commercial oTrailer Court 0 Motel ❑Other .. --- ------- --------- t. .�C..f-(..�. sr�,t _----------- - Number of living units:_ Number of bedrooms .......Garbage Grinder --------- _ Lot Size -__.Private Water Supply: Public System and name _-....._..--..---------_---.--------------------------`-�---- _-------. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q' Clay Loam i❑ Hardpan ❑ Adobe ❑ Fill Material .-- ---- _--If yes,type----- -----------•---- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) U NEW INSTALLATION: (No septic tank or seepage pit permitted if imblic sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC/TANK[f Size.. __er.I�..�e��--- s --/2 .... Liquid Depth ----_--- Z-------- �, Capacity 110 BC? ` -.. Type `cQ ._. Material_ Q s--.- No. Compartments _s+ ............ a1z Distance to near t: Well _.--- - --------------Foundation .----/.P.t--...... Prop. Line ------ LEACHING LINE ['J/ No. of Lines ._-------- . Length of each line-27V..�.--- ------ Total Length -•-- 'D' Box ..k"'._ Type Filter Material ..-.5.- _...Depth Filter Material -.-._j..`.I'-'..__---.._._-,.__---- r Distance to neatest: Well _.40.1 ------- Foundation ._....L _--.---_ Property Line --.4._..---_...... SEEPAGE PIT [ ] Depth .....---....... Diameter ..... Number . __ ..- Rock Filled Yes ❑ No Water Table Depth ---- ------------ _--------..................Rock Size --.---...._....------------- Distance to nearest: Well _.-_-........................_.-_---Foundation __.-_-.._------ Prop. Una ---_----------•----.. t REPAIR/ADDITIOtI(Prev. Sanitation Permit#•------......... ............ --- Daft ..........................—.-) Septic Tank (Specify Requirements) --..... ------- ------ _......... .. . .. Disposal Field (Specify Requirements). ..------ ------- --------------- ---------- ----------------- .... ---. .. ----. ------------------ --- -------- (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 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 Work goq s Compensation laws of California," Signed _. .. .. .... ... .. ..�'/1 - - - - --- -- -- A ,f) i - Owner /Y�. -17- -- Lt --- - Title . (if other than owner) FOR DEP RTMENT USE ONLY APPLICATION ACCEPTED BY; --- •..—._—.. .--------------....._...... - DATE ..6_'-1..3:'7�.. - - - BUILDING PERMIT ISSUED ------ -------------------------------• ....... :------- - ..DATE --------------- -------------------- ADDITIONAL COMMENTS .-.. - . ......... — - --------------------------------- ---------- ....:.- . .................. - ..-.................... - ...,-------------- ----------------- ------------------- - .-...- -i --- -----------... --- - -.- - --- ------------- --------- — ----- - ---- - - ---------•- Date :1- �' 7 --- ----------- Final Inspection by: --- ------------ SAN - - ---SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M