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FOR QFfICE USE: � .. APPLICATION FOR SANITATION REKNIT lCon+plot*In Triplicate) Permlt No.71.4 ....... This Permit Expires ] Year From Date Issued bate 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/LOC ION ......CENSUS TRACT .......................... Owner's Name _ � = Phone ................................................................ Address •`-''-°"�•--•....................city ............................................... ........... ......... ...... -�j Contractor's Name --- L€Dense - .7� Phone Installation will serve: Residence 21 partment House] Commercial OTraller Court lQ _ Motel•p Other - - - - Number of living units:___...__../Number of bedrooma� Garbage GrindeLot Water Supply: Public System and name i............• .Private Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay eat ndy Loam 0 Clay Loam ❑Hardpan 0 Adobe ill Material _ . If yes,typ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse s(dej NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK f J Size................................................ Liquid Depth Capacity Type ------- ------------ Material---------------------. No. Compartments ...................... Distance to nearest: Well .......Foundation . Prop. Line -----------........... LEACHING LINE { J No. of Lines ...................... Length of each fine.:.................._....... Total Length 'D' Box .... Type Filter Material ....................Depth Filter Material ........-................................... Distance to nearest: Well ........................ Foundation Property Line ..............__..:.I SEEPAGE PIT { ] Depth -------------------- Diameter •-......... Number ---------------------------- Rock Filled Yes Q No Water Table Depth ................................................Rock Size ................................ Distance to nearest- Well ........................................Foundation .................... Prop. Llne .................. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. Septic Tank (Specify Requirements] --- ---------------------------•---.. / .. ......... ---- --- Oisposal Field ,(5pecify Requirements) � .............................. - - X - ...... - �.. ..... ............................. .------•---•--- -----------------•--••--- ------------------•--.......--•------------•-•------•--••....._.- .......---........... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin ' County Ordinance%, State Laws, and Rules and Regulations of the San Joaquin Local Health,,Dlsfdct. Home owner or licen- sed agents signature certifies the following: "I terrify that in the performance of the work for which this permit Is Issued, I shelf not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --- ---------•--•-••---------------••---------•--------- -•------------................. Owner By -----•-----------• ------------ --------------------------------------------------------- Title ---.....--- .-- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -_-• -- - ADDfT10NAL COMMENTS --------------------- --•---_-- BUILDING PERMIT ISSUED .----- .-... 7 DATE---.•...--•---------------- ----_-----..._ --------- .......... ----------------- ........................... . ...............•-.._..._...---- -----•-- Final Inspection by: -------------------- •----------••-EH 13 ----..._ dote .....$'-moi ............... .. .... 2 1-& Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M