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_ FOR OFFICE ltSE, APPLICATION FOR SANITATION PERMIT r ......_.._.... _...... (Complete In Triplicate) PetmN Mo. ..................... ... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herisk described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations ✓: .JOB ADDRESS%L TION .... .�: .. �1.T.. ........ ..........CENSUS TRAC`TcR:..............»{ Owner's Name .C'✓1//�lrr . .axG /, zo.........................................................Phone ..........0.........._... w Address ............................... �!l-/JJC,�-�......................................_......_City .....................»........... Contractor's Name ..................r...x!�Llrw�y... �..:.......................»...........License � ........................ Phone ...............».. Installation will serve, Residertc -"Apartment House❑ Commercial❑Trailer Court Motel ❑Other ............. .............................. Number of living units,---..-.... Number of bedrooms ......Garbage Grinder ............ Lot Size ..................................... Water Supply: Public System and name .-_...........................___..............--............_......._......................__......Privati yp Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom Q Clay Loam ❑ , Hardpan Adobe❑ Fill Material ............If yes,type............... ............ tPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK T ) Size................................................ Liquid Depth ..............----- - Capacity .................... Type -------------------- Material...................... No. Compartments ................I.... Distance to nearest: Well .--....._..........................Foundation ...................... Prop. Line ......---------_--- :EACHING LINE [ } No. of Lines . ...................... Length of each line............................ Total Length .......................... 'D' Box ............ Type Filter Material ....................Depth Filter Material ........................................ Distance to nearest, Well ........................ Foundation ........................ Property Line ..........:»:,....... SEEPAGE PIT ( } Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ 140C Water Table Depth ................. ..............................Rock Size..................»..»..»... J Distance to nearest, Well ..................................... Fovndatl all ....... . . ....... Prop. Lkse ........._.._..._ REPAIR/ADDITION(Ptev. Sanitation Permit$ ..._ 7 . Date ��r `- - ) Septic Tank ISpeNfy Requirements) . . ........ ....�........_..»......�..-....�. .. •.-7//yy.Q>�`.,�(r�. . �. -••••I)f ntf)..... .. -DisDosol Field (Specify Re uireme 5w.,C4 .................................................._....................................._..............�_....... .•=.-._-..-.•:..c.•»s.. ....................................... �....................------....................... ---. .......---..._..............................»........... ......... _.......»..._.a..»..•..•.•..: •._•-..•. [Draw,existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done M accordance with Son Joaqul County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or lice! sed agents signature certifies the following: r "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such mann as to become subject to Workman's Compensation laws of California." S.gned ..........................................................................................>( Owner : i By _. ......................................................................................... 7itle ........................................................................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... .� ... ........................................................... DATE ......� ...�j.. ..7 ..........: BUILDING PERMIT ISSUED .. //.... ..Z. .... .......... -t :.... QA. T -. ADDITIONAL COMMENTS .. ...... ...........:.:...o.....?.y.�.�..�...t('%9..�..::: : _ ... .:.. ......................... ................................... . ....... .... . .. ........................... ... _. ......... ../j.. .. .. ....... Final Inspection by: ... • --.... .. Doh . _7,(•....--.... *t EH 13 2L 1-68 itay. 91 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7It 3M