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f FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT ..... .... ......................... Permit No. ...73~.9- (Complete in Triplicate) .............................................. This Permit Expires i Year From Date Issued 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/LOCA .'. ._ ...---......CENSUS TRACT _.............. ......... Owner's Name .................Phone J-.l m.2wat......... Address .......................... �.g.. .......r�. :.... _ :. CI ...............I........................ Contractor's Name ........ ......... ... . .. .. Fes............................license # 2-:-5 -3. .3. Phone 5f4,6.-YAA7.. Installation will serve: Residence `A Apartment House Commercial Trailer Court 0 D .� - I y A . Motel ❑Other............ . Number of living units:.---- .:... Number of bedrooms ...r.Garboge Grinder ............ Lot Size ........ ....... Water Supply: Public System and name ................................................... ...........................................................Privatex Character of sail to a depth of 3 feet: :.:Sand Silt .!-:Clay. Peau Sand Loam Clay Loam x i Hardpan ❑ Adobe 0 Fill Material y65.type ' (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 ,j sower is available within 200 feet PACKAGE TREATMENT . j ) SEPTIC TANK Y Size...S.—K�............................. Liquid Depth . ................ Capacity ! .-..... Type _100#4-t...... Materl`01_6 �.4__ No. Compartments .:�.............. Distance to nearest: Well ........ ....................Foundation .....A(A.._._...... Prop. Line .�.fi...._. LEACHING LINE No. of Lines .......Z_.--------- Length of each line./00.-�-O.... Total Length ................ ' '- 'D' Box ..._.✓ Type Filter Material 4&a ...Depth Filter Material ._./.1�......... .......... ........... .. / ' r e it Distance to nearest: Well .7 IP. . foundation h t Pro Line. ' .... ... . ........ ..._ _... .......... party ........._._.......,.. SEEPAGE PIT ( ( Depth .................... Diameter ................ Number ............................. Rode Filled Yes 0 No Orn ` Water Table Depth ............ .................I................Rock Size ..................... " Distance to nearest: Well .........................................Foundation _......... . Prop. Line .._ ...._ REPAIR/ADDITION(Prev. Sanitation Permit# ................�.......................... Date ........... ..� Septic Tank'{Specifyf R�equirements) _e ... ............ . ....---........_. .. Disposal Field (Specify Requirements) .................. ........................... .................•--•-. --•---.........-----•....... IVE f ...............-.................... .........................................................•---•--...... .. . .........................--•-..... ............--------...._.._-----....--------- .......I............... i . .........................I .r....::................ . ...................... Draw existing and re uired' ddition on reverse-side I hereby certify that I have prepared this application and thd + t•the work will bo 'done In accordance with Son Joaquin County Ordinances, Stato Laws, and Rules and Regulations of-the San Joaquin Local Health District.iHom• owner or licem sed agents signature certifies the following: "I certify that in the performance of the work for whichthis permit Is issvod, I shall not employ any parson In such manner as to become sub)bct to Workman's Competssatlon lawn of California." —` Signed ................. ......:� �...._....---••....................... Owner By ................ ,----- ......-.............................. Title ....... sn--.............................----............... �Vfotheir n owner(-' !' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY_._ .................................... DATE ........... BUILDING PERMIT ISSUED ................DATE -ADDITIONAL COMMENTS .........................................................................................................................................._..--...._....... ..............I....................._ ............................................__........._.._.........._ ......_..._. ................_,...............---........ •..---.. ! ._........ 1 .i. kIna Inspection ..................... ....................................................._...... ....1 ................ . . -. ... ._.... Ay . ......... ........................................._Date ........,..<-.. .... ........__. SAN JOAQUIN -LOCAL' HEALTH DISTRICT t"