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FOR OFFICE USE: - � FOR OFFICE USE. PPLICAT(ON FOR SANITATION PERMIT -----•--...-••-•-------:...................------------ Permit l (Complete in Triplicate) -•-------•-- ---•-•--- ••- w'fs Date Issued.n/j_.,70 ............................. This Permit!Expires 1 Year From 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 - ---- TRACT--------------- ------- ------ CATION.....�.- ��........ ..-�----- - ------------ ---- -�---- .. Owner's Name.-- .. ...... ....... .. W. G(1 . -- Phone..J�------;�---77 Address _� _. _.__ ... Ci__ ------------ Z1 s2��. . tY p Contractor's Name. .... ......... .........License #�S�"��-3_.......Phone._ ..� �f.�Z_...:... Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other..... -------------- Number of living uni#s:..-----1........Number of bedrooms....y .Garbage Grinder._..----.. Aot Size__ C -.x -. ----=-- - Water Supply: Public System and name-- ............... --- --------------------------------------.....-- ----------------- ---------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat ❑ 'Sandy Loom 0 Clay Loam ❑ Hardpan ❑ Adobe Fill Material _ .... ....If yet, type... ............. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must b.e placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT [ } SEPTIC TANK [ ) Size ..........----------.. ----- •------- - --Liquid Depth------------ ..-----.. Capacity Type-: Material--------•-------••-------,No. Compartments-_------------------ ------- -- Distance to nearest: Weil---- --------- - -------- ---Foundation- ------ ----........'Prop. Line............ •-----e LEACHING LINE [ .) No: of Lines..:-----------------------------Length of each line. ----- ------Total Length .- ------ -----=-------- - D' Box.............Type Filter MateriaL..-.. -............Depth'Filter Material-------------------.--- _. Distance to nearest: We1L._... Foundation--- ---. ..-:...:_Property .Line---------- -- ------------ ------ SEEPAGE PIT ] Depth. ._..__Diameter.., 3 ..........Num ber.._.__ I____________________ Rock Filled Yes No Water Table Depth ---- -- ---Rock Size /Y_ 'II!". � ` -------=------• ---- �. Distance to nearest: Well------------- Foundatiori � --- -. ......Prop. Line..3..... ......:....:.. REPAIR/ADDITION (Prev. Sanitation Permit#..__..._ Date---- _- = ) Septic Tank (Specify Requirements(......... ......• .............. . ----------------------------------------------- Disposal -- •-_---•---- - -- Disposal Field (Specify Requirements).......-' = ------ -------- ---------- ----- - ------ ----- -------------------------------------------------- ... ..........................................--- ---- - (Draw existing and required additionon reverse.side) I hereby certify that l have prepared this application and that the work will be done in.accordance with. Sart Joaquin County Ordinances, State Laws, and Rules and Regulations of .the: San Joaquin Local Health District, Homeowner or licensed agents signature certifies the following: "I 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-------- ---- -- :-------- ------ c. ---------•-------- - ----Owner . BY_-------------- ---- - ------ - -------- -- - ------------------ .......... . ' - -- - ----------------- - - If other than owner) FOR EPARTM SE ONLY APPLICATION ACCEPTED BY ------ .DATE ... - - - ----- ""--.-- -- --- DIVISION OF LAND NUMBER.= -'-•- -- DATE.... ADDITIONAL COMMENTS------------- ----------------------..... - -- - - - -- ... ..... .. '... .. . ..... __ Date...Final Inspection by F&S 21677 aev 7�76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT