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FOR OFFICE USE: APPLICATION -AOR SANITATION PERMIT a Permit No. .. ,. � .. (Complete in Triplicate) ......................................... This Permit Expires 1 Year From Date Issued Date Issued .! �7 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: L � - II JOB ADDRESS/LOCATION .:_:...... .-- .�--- �L�/. '.. .. ... ..........................:...............CENSUS TRACT .:................. ....... Owner's Name ..... .__.. .... ... ... ....... ........ cc-- Phone Address ............... -..�P:::.. ----- X ..-----------•-_. City -- ............---•--.. .......... Contractor's Name .... .. .............•- --------....License # - y'.=�_ _ Phone . J2 Q. Installation will serve: Residence)§Apartment House f3 Commercial ❑Trailer Court 0 �i Motel ❑Other --- ........................................ Number of living units:---!--..:... Number of bedrooms _.v._Garbage Grinder .. __.__. Lot Size ...... K/ ... } Water Supply: Public System and name .............................................................-_--.. 1 ......................Private El Character of soil to a depth of 3 feet: Sand Silt 0 Gay ❑ Peat j] Sandy Loam ❑ Clay Loam Q Hardpan ❑ Adobe Fill Material ._._.__ _... If yes, type ....___ ................. 1 - . (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 200 feet,) V PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size................................................ Liquid Depth ......................... Capacity ..................... Type -------------------- Material..........----=......... No. Compartments ..................... Distance to nearest: Well ------------------------------------Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ........................ Length of each line----------------- ........ Total Length 'D' Box -----:X': .. Type Filter Material _-----------------Depth Filter Material ---•.................................... __ Distance to nearest: Well- __.-•---.---------Foundation .-.-__------_ ....... Property Line ........................ r SEEPAGE PIT [ 1 Depth -------------------- Diameter -......_. ..... Number ..._..------.----..__------ Rock Filled Yes ❑ No O Water Table Depth -=-----..........................................Rock Size --------------------- Distance to nearest: Well ........................................Foundation - .................. Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation'Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) ..-----...---•............... -•-•---•--.r.......................•............. . - Disposal Field (Specify Requirements) .....cam-(:,0.-...600 ---- G-r l �Q�Ls-cz --------------••-------.._................._. ..........--------------------------------------•-- `___Y_---.F� ______________________________kT_. ._ ...._ ..._.._____.._.._.._.I................._...._. �.. ____________ _ _ A�'�. !Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Sort 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 whick this permit i-s isived; I`sholl not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .......----- .... Owner a By - .� . ...� =_.�m� ;title .. ,- (if other a owner) # y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY . .:--••--------------•---- `........._.... DATE `... �'1 w3 BUILDING PERMIT ISSUED ....," -------•........................ ..•-•.-.........'..-----.-. -------------------DATE .........................------- ADDITIONAL COMMENTS .......................... ................. :. a •..........--••............•.... ............................. .......... -.......................................... ............................-......--...... ...........:... .:..................... _ • Y ... ................. Y Final Inspection by: ................................I.._..--- ....Date a�.... -- _ _ SAN JOAQUIN -LOCAL HEALTH DISTRICT E..H.13 241-'68 Rev. SM., _. 7/723 ,L14