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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................... --yy (Complete In Triplicate) Permit No./..W..:. ......... This Permit Expires 1 Yeo From Date Issued Date Issued 1=9K-7,61- Application is hereby made to the San Joaquin Local Health District for o permit to construct and Install the work herein desvibed. This application Is made in compliance with County Ordinance N : 549 and existin Rules and Regulations: JOB ADDRESS/LOCATION .. ................ S rJC JG�OL�fCE CENSUS TRACT� ......................... . ........ . ........ - ...... . Phone .... . Owner's Name ... . . -'LGt.'..�-..g..i.�........... Address ... ...... .... .. ...... . 5'06. / l�!/ SJZC'c' City ..............-............................................................_ ............._....... Contractor's Name .. .. .......................................... - ..License # ........................ Phone ..................----........ Installation will serve: Residence p Apartment�H,o�us�e{f:3 Commercial C]Trailer Court ❑ ( Motel NOther ...'..11` Wy..l !�-............. L t�.�� Number of living units:...'------- Number of bedrooms ..�9..........Garbage Grinder ...:........ Lot Size ....1...`^.v�F.:?:.%.................... Water Supply: Public System and name ............... .................._............................._..........................................Prlvatew Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay e Peat❑ Sandy Loom ❑ Gay Loom❑ Hardpan❑ Adobe t] Fill Mnterial ............If yes,type............... ............ r (Plot plan, showing size of tot, location of system in relation to wells, buildings, ate. must be placed on reverse side.10 s NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet) 6 PACKAGE TREATMENT f ] SEPTIC TANK Size................................................ Liquid Depth ..................._..... Capacity lick- -..-- Type ----- Material. *r.... No. Compartments -.,a-......._...-• Distance to nearest: �.O Well ---- Q_t...................Foundati� ..P"" _._ ........... Prop.Line 99.. ...... LEACHING LINE K No. of Lines .�y^-..._ .......... Length of each line.....Jpg.............. Total Length ...100 _ . . .......16 JC 'D' Box fr4K Type Filter MaterialA -�-Depth Filter Material ....Ici. 1A Distance to nearest: Well .. Wt.......... Foundation ...I.O..`.............. Property Line .........Js. SEEPAGE PIT Depth .as.........-. Diameter ...... Number .........A.... ........... Rock Filled Yes A( No O� Water Table Depth ._..90...................................Rock Size ................... Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... j REPAIR/ADDITION IPrev. Sanitation Permit# __.._..---------....._................... Date ..................................I Septic Tank (Specify Requirementsl .................................................................. ........................................................................ t Disposal Field (Specify Requirements) ....__..........................................................................._...-'--•-•--•--.. .......................... r .. 'v '- .................................. ------`----- ............................_............................................................................................. (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 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 net employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed . ....------------- --,q .. . . .. .. Owner By . ..... ..(P! ---...----.. ............................. Title ........_...... ._...._.-.-._.. .....----_._......_...._.__.. other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- .... . .. ................. -- -- ..._..... _ ... - DATE ......�7.......1 ..... ....... BUILDINGPERMIT ISSUED ... ..... ----------------------------------------------------------------... ..........................DATE .. •... .......... ....................... ADDITIONALCOMMENTS ...................---- ---........_..........-----.....------...-.............................._.---'----------............._................. .._.................__.........----.........._......----........-............-----......................._...`-..........'........................... ............ ...._- ................................... Flnal inspection by: ....._... .tom.... . Dote z... ..7................ EH 13 24 1-68 Rev. 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 9/74 3M