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FOR OFFICE USE: �Ft= APPLICATION FOR SANITATION I�LrRMIT .................1113-------------- (Complete in Triplicate) Permit No.74_. .o3.7q . _ ei. �_ - p�._. This Permit{Expires t Year From Date issued _ Dare Issued .`?1.�. .._.__. 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 ON .....I�.-J..�.--.................. ........... ............... .............. ... CENSUS TRACT .. :: Owner's Name ... .. ........ .-......... ... ----- --.... ...... Phone . .`. � ....._. Address r� 3 ..... .. . .. ..._...:City . :..: !t................ ........- . Pr jL .. +' ..? --------.License # ..:.�`�.W... Phone .........:.-�� _. Contractor's Name .-. . -. Installation will serve: - Residence Wportment House❑ Commercial❑Trailer Court 0 Motel ❑Other------------ ............................... si r 7 x�—� Number of living units:.__....... Number of bedrooms _.__Garbage Grinder ............ Lot Size ...... ..... .... ......................... Water Supply: Public System and-name ...........................I................. Private ❑ Character of soil to a depthiof 3 feet: : Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam D Hardpan Q Adobe Fill Material ..__-....;_. Ikyes,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 sewer is available within 200 feet) PACKAGE TREATMENT [ J I�I SEPTIC TANK{ Size....... Liquid Depth Capacity --.- .----- Type _ Material---_-_-----------_ No. Compartments Disi tance.t6—nearest. Well ...................:................Foundation ...................... Prop. Line .......... ...........%Y LEACHING LINE [ j No-�� of Lines .................. .... Length of each line. ..__.._...._.._.. Total Length ............................ 'D' Box .:::- Type-Filter-Material .Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ......_....... ... Property Line ........................ U7 -____ Rock Filled Yes ❑ No ❑ SEEPAGE PIT �[ } Depth -------------------- Diameter ................ Number ...._...--•------_-.- - l Water Table Depth --------------------------------- --------------Rock Size ................................. Distance to nearest: Well ...................:....................F=oundation .................... Prop. Line ...............I...... REPAIR/ADDITION(Prev. Sa. nation Permit` ............................................. Date ---------------------------------_1 Septic Tank (Specify Requirements). ----------------- ;.............................................. ...... Disposal Field (Specify 1Requirements) .-..-�_ ---__-• - - --r. - - -------------------------............. .._ jY ----- ------------------------------.----- �--------... - . --- ----- 1� s -------------------------------------- ---------------------------------------------------- r ------.._......... "(DFaw exist#ng'and'required addition on reverse side) I hereby certify that 1 haw prepared this application and that the work will be clone in accordance with Seen Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or Ilcen- sed agents signature certifier the fallowing: "I certify that in the perforLnce of the work for which this permit is issued, 1 shall not employ any person in such manner as to Become subject to W&man's Compensation laws of California." Signed ----------------- - {� -------- _ OwnerY I By ----6----- c ---- --------------------_--.------ Title -----...- . ------------------------------ ------------------- if other `owner) 415i -- �! R EPARTMENT USE ONLY ---------- APPLICATION ACCEPTED BY -- = ..._._.. DATE ) BUILDING PERMIT ISSUED� .___`_ -- --- ---- - ---------------------------_.__..__...----------------------...---------.._._DATE ...---- ....------------... _..-. ..._.-- ADDITIONA E ------------ -------------------•---- -------------. . _ .... _._..--- _ ......_..._...----... ..._--- -. --------------- --------- -- --- .................................................... ............... f=inal Inspection by: ...... ............................................... .-.............- EH 13 24 1-68 JO UIN LOCAL HEALTH DISTRICT 8/7h 3M