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FOR OFFICE USE: ; ,iLICATION FOR SANITATION PERM--) _� � ? Permit No. _1nI'�.�.......•.-----•- (Complete in Triplicate) i ...................................... Rate Issued .Q.-..:'a�_~.)3 , This Permit Expires 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicotio is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 170cc � l CENSUS TRACT ....'J._� _.. JOB ADDRESS/LOCATION .........-- Owner's Name _... ?'.�J.IIl / ... ?' _��.........L _. Phone .... ..... . Address ...---------17n� ....... .._._ --- .............. City .4RI ............................ ................................. Contractor's Name -- i-. 911!,1 N ._.:Y`'_..Shc�/---------------•• ........ # l-� ter~ ... Phone ....-----:.................:F. Installation will serve: Residence ❑ Apartment House Commercial Wrailer Court 0 =- Motel ❑ Other ............................................ Number of living units:--'—Number of bedrooms Garbage Grinder —trot Size':.._./7-C !`r-�I Water Supply: Public System and name ....................... ................................._...-•------•.........------..��oarn Private Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .. .. If yes,type ............................ (Plot plan, showing size of lot, location ofsystem i relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) Se -r r i 6 PACKAGE TREATMENT SEPTIC ............ Liquid. Depth • Capacity 120.10 Type BC CTMateriol.. No. Compartments -••••J•_d � o _.Foundation ..�0`-•-----•--- pro Line ..... Distance to nearest: Well ....____......................... p• d Len W............... Length a�..lC'.�.........••..� LEACHING LINE No. of Lines ..._.-.?�.............. . Length of each line..... . ... Total 4 er 'D' Box .....l----- Type Filter Material J� Gc. :Depth Filter Motericil ......A.... -------•••••......-•--•••... Distance to nearest: Well ...... .............. Foundation -------------------------- Property Line _ ._r''�J. ----••-•r [ p ..._._...._......... Diameter ................ Number ....._-__--....._........... Rock Filled Yes ❑ No Q SEEPAGE PIT ] Depth tc • Water Table Depth .................................................Rock Size --------------••---------•-•---- P� Distance to nearest: Well ................ .Foundation .................... Prop. Line .................... REPAIR/ADDITION(Prey. Sanitation Permit# ------..------------------------------- ---- Date .................................. : Septic Tank I5pecify Requirements) .................. .. ... --------------........---------•---•--_------------......_......._......... I........ Disposal Field (Specify Requirements) ------------ ... .......... .............................. ........... ......•..............••--- _ .......................... ...--------------- ...... (Draw existing and required addition on reverse side) 1 hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed S� -•----------------•-----•------ Owner .......................... Title ----------- .................. (If other t `—"`�erj FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ........................................ ........................... . ------------- DATE ..------. ... . �..��...-•• BUILDING PERMIT ISSUED .............................. -••--------- ....................:DATE _........................................... • ADDITIONAL COMMENTS ................. .....------....---.....------...........----••..----------.......----...... ......................................... ...... ................... ....... ............................................................................................ ... .......... * .. -- ----.. ...... . ........---• ....._.....-----------....... .... .... ......... .-------........--.... .. .. ----... ...p ................. . ... ..... .......... Date Finallnsecti '�•� SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 M