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FOR OFFICE USE: pPLICATION FOR SANITATION PEM Permit No. _7................. ................................................... 4 (Complete 1n Triplicate) 5 ....•..............•• j., - ~ 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- ......... s= . ._.....CENSUS TRACT .......................... JOB ADDRESS/LOCATI N . - ---- .....Phone _ ' . � .s�.................................................' = - Owner's Name --- --.. '�� --- -- . City YZ1C - � .. ............. Address - ----- ' .-_- -• P �'� a Q` License . . .,�? .�.... hone - ..------ Contractor's Nome ...��.•�J-...._ a .•- ...... . .................... Installation will serve: Residence Apartment House Commercial(]Trailer Court i0 i Motel ❑Other ----••----------•-•-------..- Garbage Grinder Lot Size a ,C .P .............. Number of livingunits------ Number of bedrooms •-•--•••••-- Water Supply: Public System and name ___ ........ .... .. ........Priv to ❑. Character of soil to a depth of 3 #eet: Sand n Silt❑ Clay [3 Peat Peat❑ Sandy ❑ Clay Loam Hardpan❑ Adobe C3 ... Fill Material ......... 1 yes,type ............... ............ must be placed on reverse side (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} Size:---•-•••==.......................................... Liquid Depth ....----•----•---.......... F PACKAGE TREATMENT. [ ] SEPTlC TANK{ ] , .. Material....•_--._•..--. _ No. Compartments -----------------••--- Capacity ----.....---•-••---- Type -••-•---•----..._. --.•- ...Foundation ..... Prop. Line -----••-------•-----•- Distance. to nearest: Well --------------------------•.----- •---....... ..... Length of each line..-.- Total Length ---------------•----••-•---- LEACHING LINE [ ] No. of Lines ..................:. g -D' Box Type Filter Material .......Depth Filter, Material ..............I.................•......... a ._....._.... •........ Distance to nearest: Well...... Pro................... Foundation ---....-------•••••=-•-• Property Line I SEEPAGE PIT [ j Depth ._._..-----••...-_-- Diameter ----•--•=---•-- Number --------------------- Rock Filled Yes ❑ No 0 Water Table Depth ........ ...................... ................Rock Size --••---•---------------.. .----- Distance to nearest: Well ..........Foundation . Prop. Line -----.--•-•-••-••----- RIcPA1R/ADDITION(Prev. Sanitation Permit# ..........••-•••_••----•••••--•---•••••----- Date . ----•----------•---•-•-_---------) I -ESeptic Tank (Specify Requirements) _...-:--•-----•-•--....... --••-•-- •__..... ... _ . . -------------------------- Ipisposal Field (specify Requirements) �w� .•� .............•..----------------- ---•------•--- ............ 1'. .- . -_-..•.....--•-- ...._..... (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 Joaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Hone owner or 11cett- ( sed agents signature certifies the Following: arson in such mann "I certify that in the performance of the worts for which this permit is issued, I shall not employ any p as to become subject to Workman's.Compensation laws of California." Signed -�, � --------••-----"-------------- Owner By .. .r.".. / (If other than nerI FOR DEPARTME T USE NLY APPLICATION ACCEPTED BY _.......... .. ............ ._._ Y L = •. ---- ��` DATE .-..7:��>'/ BUILDING PERMIT ISSUED ----------- ...---•...--"• ------ ---- ........................ ..._.._.._ •--�--------------DATE ............_._.._....._...-_..._....._._.. ADDITIONAL COMMENTS ..._..----•....-.--------------------— -----------••--------.......-------• ----- ...._-..__.._........_...._..-..._._._:_. -•• - ...".................................--- . .. _... --••-- -•-- y ...... ........... ........ ...... . i' Final Inspection by: . .....-.• ... -----•.Date ... ... .1 ✓....... 8/74 3M EH 13 2h 1-68 Rev. % SAN JO QUIN LOCA. HEALTH DISTRICT