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4PPLICATION FOR SANITATION PF"11T - ----------- " ~ (Complete in Tripllcaie) �'' Permit No. ..............._'t: .................... This Permit Expires i Year From Date Issued Date 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: JOB ADDRESS/LOCATION .4. . S[...__ . .. . . - -----• ------.�....---...._.. ..... ......................CENSUS TRACT ......... ..............._ - chi Owner's Name . -_.....7...... r - Phone ..L??.�--.b ,7......._. Addressd�(f�0 ._. . .... --- --. .. . .... ._...............city .... .... .. ..... _. .........- ....,,.. ................... Contractor's Name ----------------------- -- - - �...' ..............License #17i �f%��..... Phone .YTab QZ...... Installation will serve: Residence❑Apartment s�House�0�jj Commercial❑Trailer Court D .. / Motel ❑Other Number of living units:-----L. Number of bedrooms ....�4....Garbage Grinder ............ Lot Size . ......... Water Supply: Public System and name .......................................--....................................................................Private " Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe j 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,[ fr PACKAGE TREATMENT [ ] SEPTIC TANK YP „ .1 Capacity ��. .................. . Liquid Depih ...Mrf............... Capacity lkcv- --.._ Type .. r. MaterialkA.V,61d.. ... No. Compartments .....................�1 Distance to nearest: Well ............ . . ... ...............Foundation ...-�.Q..�......... Prop, Line ... _f 'DO I LEACHING LINE No. of Lines '..14Z...----------- Length o ea line-.!... -.._....... Total Length p J.Z.0...............5 D' Box _-......... Type Filter Material ......Depth filter ,Material ......../fl.. .._. ...... ......... 4- Distance to nearest: Well ...... ........_ Foundation -.._lQ: .-t:__. Property _Line . .....�............. SEEPAGE PIT �y Depth ---;�_-...... Diameter ------ Number Rock Filled Yes No Q Water Table Depth .. ?. . _ Rock Size3t .._�r�} �...:... t Distance to nearest: Well ......./r . .................... _.�0_. -„- Prod. Line _c ............... REPAIR/ADDITION(Prev. Sanitation Permit# ..............------------m................. Date ........................ ---------I Septic Tank (Specify Requirements) .. .. .._.......,....... DisposalField (Specify Reuirement ...__------------------••- ------------..-------- .....- -- - ------------'---------------------------.------.............. ---- --- ----M ------------------ .................-- . ------........... --•--- ------... ............--_ ......... •-----... - ......--1 :........ --------------------------------------- --- ------. --- ... -- ----------------..._........-----........._........................... . (Draw existing and required addition on reverse side) 1 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 Son 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, 1 shall not employ any person in such manner L as to become subject to Workman's Compensation laws of California.” Signed . - ---.. ._.--- ------ - - - -- - ----- 1. -- Owner L By r' - l, --- ............ Title ....... ' (If other t an nerl FOR DEPARTMENT LI ONLY. LAPPLICATION ACCEPTED B . --- -, - ---. DATE 14? 7.7.S..'_ _ -- _ BUILDING PERMIT ISSUED -------------- - ----- - - - - - -- .....---.DATE ADDITIONAL COMMENTS - ------ -- _- - - ------ ------- ----- ------ --------- --- - ..... L - -..----- .. -- ----- .M ........ ---- .......... ..... ---- - --- ----------- - - -- ----- -- ------------------ - - - -------_-----------------------... - ------- ------------ --------------- __..... - - -- -------- - ------- -- --... - - - --- ------ ---------- - •--------------------- ...... - -- .... - - - -- IL Fnai Inspection by: .. .-:...... •--- :_--- -------------- ---------------•. ---- ....- ...... ... .......:?....Date ._..-/4- 1. ..... ...... Ell 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH STRICT 8/7h 3M