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t-UK Urr-It.t WL; ................................................ PLICATION FOR SANITATION PERy" (Complete in Triplicatei Permit N O. . ................ j This Permit Expires ] Year From Dat&Issued Date"lasued:.7:..3._7..�. r .....__.....•---- i Application is hereby made to the San Joaquin Local Health District for a ermit t described. This appl 67 ian�i made in compliance with County Ordinance No. 544 and etxisting Rulesand tail the work-nd Regulations,em 1 U w JOB ADDRESS/LOCATION � ;� � I� •-• .....CENSUS TRACT Owner's Name .--- ...... ............. ... . _ .? .�-„ f .... ... ......... , .PhoneAddress ...... ...... ............... ` .._ Contractor's Name . .. ... ..._...... City .... ._._ :.. ....-•-ue = .......License Phone C! ----•- Installation will serve: Residence A artment House Commercial )]Troller Court Motel Q Other ' Number of living unit's:.....j..... Number of bedrooms ___ ..__Garbage Grinder Lot Size .: Water Supply: I - ................ Public System and ...............................:..._..:...- ......Private [� depth of 3 feet. � -..---•---..._........:............•-,....-----....... name. Character of soil to a ,nd El Silt❑ .Clay p Peat❑ Sandy Loam fl Clay Loam [] Hard an � ' _ o P 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 208 feet) PACKAGE TREATMENT € ] SEPTIC TANK S I Z 0.S _ ' ................ .Liquid Depth _:Z.................. Capacity� .c_��;...._.. Type d ` Materiai_... .. No. Compartments p rtments ............... Distance. to nearest. Well - a ` 5Foundation LEACHING LINE I'J .....L_�..�...._.. Prop. Line ...:................. No. of Lines _. __ D' Box ..---• .... Type Filter Lets th of each line..---- ............... Total Length Awn . Material .. � -'- Depth Filter Material !.. ............................. Distance to nearest: Well .....->r�'.�_•• S- .... Foundation ...._l.-' ....... Property Line SEEPAGE PIT ”` (r] Depth 2..- .. .... Diameter g ----.. Number ...........3......._. Rock Filled Yes Er' No Water Table Depth .......... Ze c' .. -..-.._..Rock Size 3 �•,r'/ F ,f. Distance to nearest: Well •- Foundation - ........... Prop. LineREPAIR/ADDITION"(Prov. Sanitation Permit .... s ' ""'• -----••-- -------••-•--•---•--•---•---•. E+ Date ._.......-•----•--- I Septic Tank (Specify Requirements) ...... Disposal Field (Specify. Requirements).' ...................................................... ------------------------------------ .............. I •------------••-------•...........................:.................................... ------•---------•------------------------------- --••- iDrow existing and required addition on reverse side) '- ! hereby certify that Irhave prepared thiapplication and that the work will County Ordinances be done In accordance with San Joaquin State Laws, and Rules and Regulations of the San Joaquin Local Health;Distritf."Hom& owner er Ilcen- sed agents signature certifies the following: "1 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 Workman's Compensation laws of California." Signed i - -- -• - .. Owner. By ..................... ....... .:...................... .yam -----•---------- e2�c«r' .. . 1 (If other than owner) . Titl . _. W FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... BUILDING PERMIT ISSUED........ ..... -- ........... _... ..............._... ......... ........... ....... ... . DATE . .. . ADDITIONAL COMMENTS, .................................. DATE ----...------..................I._.._..._....._ .......---..._.._. : ......._._.........,....._....._................__...........I.._..........• .............. ._.._.. ..................... . ... ... .. .......................:....................... FinalInspection b ---- -----•................................---...--- ..........:.....----------f. ........•.................................................................... EH 13 2!t 1-68 d_v. 5M Dare . 1.�.. .... ..................... t AN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M