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r n wrrtt.c uoc: APPLICATION FOR SANITATION Pr-MIT ` - (Complete in Triplicate) Permit No. .1......:........... This Permit Expires 1 Year From Date Issued Date Issued �.0 .............. ` 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. J08 ADDRfSS/LOCAT _ J 3 Sr !L. C W r.� CENSUS TRACT _.. -- .... ...... -- -....-._ --..... Owner's Name .._. . ...Ci.LY / - --rte - �...... ��-'---........__............._•..---.....---......................_.Phone ....'�/..�/-------��--- Address ._ .-._ .. . f�CJ.-- --_.. a �- 4 r?.C.-�/(�e(c�- ---------------------------------- Contractor's City .._ t"_. a/L...... Contractor's Name ---.-d.W-.ve r------ o r -�c/pp1_.. _ License# ........... 1' �,_/ ......_ .......... Phone .......................-••-- Installation will serve: Residence JrApartment House❑ Commercial ❑Trailer Court �] LMotel [I Other Number of living units----- Number of bedrooms -17-----Garbage Grinder .... Lot Size .__l0 /- e r Wafer Supply: Public System and name -------------------------- ......... ----------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ peat❑ Sandy Loam ❑ Clay Loam J Hardpan M 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENTII--••. [ J SEPTIC TANK PQ Size.l.-. �,��...5............. . Liquid Depth .-..�..__..-......-. Capacity 1_2_.a©......-- TYp 1 r...... Material..._ No. Compartments r-.____�.� Distance to nearest: Well `..........................Foundation ../�....____..... Prop. Line ._S .....:.._._...� LEACHING LINE ( J No. of Lines .. ................... Length of each line....?.ti(�_..-_----.-- Total Length _12 ............ 'D' Box Type Filter Material ..: :.......Depth Filter Material .... ...............................1/t Distance to nearest: Well —i_ P ? Foundation ---��. ........._ Property Line S SEEPAGE PIT [ J Depth ..�.5- ...._. Diameter ..J.__..._--. Number .......2-:................. Rock Filled Yes4} No Q Water Table Depth .---./.. O.................................Rock Size ... ,,..':!'T-'................. Distance to nearest: Well ....f.. t.'.........................Foundation ..Z.`�............ Prop. Line '......_........... REPAIR/ADDITION(Prev. Sanitation Permit# ............................-............... Date ......................._.........I SepticTank (Specify Requirements) ............................ ................................................_.....--......................................_........... Disposal Field (Specify Requirements) .................... . ..................... --'---.............. .............. .....................m............................. --------------------- ---- ---------- ------- -------------------------------............................................................. ..........................-••-- .� ._.-.-... ....... ....................... (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 a tthai:fer formance of the work f r which this permit is issued, 1 shall not employ any person in such manner as to becom ubjeco 's Com sation laws of California." Signed - � - -------------------------- Owner By - .... ....... ----- ---- ----- ------------------ ditle ........----..-..... - ..........- _ _ (If othe FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- BUILDING PERMIT ISSUED --.- - ... - - --------------------- -------------------- ------ ---------------- ------ DATE ADDITIONAL COMMENTS .....-.... - - -----' .. .. . _. .rte , ' - Final Inspection by - _ ' --------------------------------.................. . . Date r: .... .. EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7L 3M