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FOROFFICE USE: IT ,�� APPLICATION FOR SANITATION PERM lei .Ix ....... !. ,r7 ........... � - . ' (Complete In Triplicate) Permit No. y7. ....... ..................................... ................................ .......:..... 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 wm* herein described. This application Is made in compliance ith County Ordinance No. 549 and existing Rules and Regulations: .TOB ADDRESS/LOCATION ..._....... .........CENSUS TRAGI Owner's Name _.... Address - � :��__......... ......... ........ Phone _..--- Contractor's•Name �� - ............. .... _..... ------� ...License # �` l _s,J�+ Phane '.�E'. �✓ . .............. i Installation will serve: 1)r Residence edA artment House Commercial QTrailer Court Mote/❑ Other=-•- Number of living units:..._-/ Number of bedrooms _..-Garbage Grinder O�- Lot _- 17 'l -r-- •--•- Water Supply: Public System and name &9-�-,0VJA1JW1/ - --.. .Private❑ Character of soil to a depth-of 3 feet: Sand ] Silt 0 Clay ❑ Peat n Sandy Loam D . Clay Loam r ` Hardpan ❑ Adobe;,.Fill Mipterial ...... if yes,type (Plot plan, showing size.;of #ot':#�tion 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,! f PACKAGE TREATMENT [ J SEPTIC TANK l Size.................... Liquid. Depth .........._.............. Capacity --:,-------� Type -' . Material......-............ No. Compartments Distance.to nearest: Well .......... - ...:....................,_Foundation ............. Prop. Line LEACHING LINE [ j No. of Lines ........................ Length of each Zine.......................... ............. ... Total length r f 'D' Box Type Filter Material ......................... . . Depth .Filter Material ' Distance to nearest: Well --� .........-•••-•----•.... Foundation __.. Property Line SEEPAGE PIT [ ] ': Depth . Diameter ..._. Number ...... --� ------••5---------• ----------------•-•-------.. Rock Filled Yea Water Table Depth ...............................................Rock Size Distance to nearest: Well ........................................Foundation ......... Prop. Line REPAIRfADDITION(Prev.'Sanitation Permit # .......... Date I Septic Tank (Specify,Requirements) 1 Disposal Fi d (Specify Requirements) ', -{ , �"_•_ � ( -- r f ...... -----•- -------------•------- -- ------•--•--------•- - .... .. ................. ............ ................. (Draw existing and required addition on reverse aider I hereby certify that .1 have prepared this application and that the work will be done In accordance with Saes Joaquin County Ordinances, State Laws, and jRules and Regulations-of-the Son Joaquin Local.Health:District. Name owner or licen- sed agents signature certifiesythe following: "I certify that in the perFormance of the work for which this:permit is Issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.,, Signed .-- ---.... Owner T By -- -------------- Title _. a (If of an owner! d" �`... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... BUILDING ----- -- .. .. -• -- ---..-•------- -------••-- . DATE -- � _ `�- BUILDING PERMIT ISSUED .................... " --.-.- ---•• ---- .....DATE -----------------------------•----....... . ADDITIONAL COMMENTS .------....... ..............-- - --...._.. ------....------•----•-------•---------•-�.. ._.._._ --•--- -- .............. ..--- . •---.. ----------------------••- ...... ••---...... �4- ............... r ,n.. ..r Final Inspection b ------- -------- ----------------•---••----•--...-----=•--:-••- -••----�.------------- -... ._.._ _ .._._._.__...._. ...._.............. p y: .-. -__Date -77—/ - ETi 13 2I� J.-68 Re - - .................. S OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M cdz>