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FOR OFFICE USE: APPLICATIOI#-F0p...SANITATION PERMIT Permit No. —31b (Complete in Triplicate) ' This Permit Expires 1 Year From Date Issued Dote Issued 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: ]OB ADDi?ES5/LOCATiO o 1�--- .- -!!^[.<4 ............._. .. �... ... .... _ --- ..... ..CENSUS .... �,{ C TRACT..........--, Owner's Name .._.._.... e............ .......... . ... .:<..... .... ,............ one —� �� ...... ...._.......Ph �1�� Address ........ ......... f` 4........... ...... .... . ...........................City ...I...---- Contractor's Nome ..License # ` _:3 . Phone7o(a. Jam... ......... _.. . ........--•- - ...�:.- icy..................... 6a,2; Installation will serve: Residence Ppartment Houseo Commercial oTraller Court 0 ' h� // Motel ❑Other............................................ Number of living units:-----(-..... Number of bedrooms ....YGorbage Grinder ............ tot Size ................................ -.......... Water Supply; Public System and name .............................. .Private' Character of soil to a depth of 3 feet; Sand Silt❑ Clay Q Peat❑ Sandy Loom ❑ Clay Loam Hardpan(] Aclo6016 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 INSTALLATIONi (No septic tank or seepage pit permitted If public sewer is available within 200 feet,j PACKAGE TREATMENT SEPTIC TANK ` ........... Liquid Depth ..........rr Capacity .. .�....a _ M ._ - • -. o. Compartments .. ............ . Type Distance to neorestt Well ......_.,�d.'f................Foundation ....t4....._..._.. Prop. Line .�.:?''�........._ g i r + t7a LEACHING LINE No. of Lines ........................ Length of each line._._. .a'�. � c2Total Length ..c .............. 'D' Box � 'I Type Filter Material Depth Filter Material _.. ..lZ .............................. A Distance to nearest: Well ,�-. ------- Foundation ..../ '`f" Property Line ��' SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ........... Sire ..._............................ Distance to nearest: Well Foundation Prop. Line REPAIR/ADDITION(Prev. Sonitation Permit# .................... ................... Date .................................. a Septic Tank (Specify Requirements) - , ,r 5 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 Joaqutn' 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 "I certify that in the performance of the worn for which this permit 7s Issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.' Signed .............................. ........... Owner Owner ----------. Title By ........_..I. .....I. -_....... i (if other t owner ' FDR DEPARTMENT USE ONLY PLICATION ACCEPTED BY..... DATE ....S. 7. 3 AP BUILDING PERMIT ISSUED ............................. . .. .-•---....-•----..._--- ... •--•- -•.........-•.................------.....••••..I.---........--......_........................DATE ADDITIONAL COMMENTS Fjnai Inspection b*, ............................•----.... --.......-•---._............................................_.... . . .� 3 1 .........._.... . . ...................... :Date ........ J.............................. SAN JOAQUIN LOCAL HEALTH DISTRICT 1.3 241268 Rev. 5M 7/72 3 X QPE