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FOR OFFICE USE: APPLICATION.ICOR SANITATION .PERMIT ....... .... .............. ............. Permit No. IComplete.In Tripiicatel ................. .............. This Permit Expires 1 Year From Dot*Issued Date Issued ..:F.............. Application is hereby made to the San Joaquin local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regufationst !OB ADDRESS/L, ATION ../V,*......................CENSUS TRACT ................:......... Owner's Name ..._ �.. ._?' �..- ......................................... Phone :. . Address .c�.1.....t; ..............:....... ...... Contractor's Name Name .. _- . . ..�E;�Apiairtment �� rPhone t �..... !2..� .License � .... ............... Installation will serve: Residen House-[] Commercial ❑Tra#lor Court 0 Motel ❑Other Number of living units:....I..... Number of bedrooms .._.?:��Garbage Grinder ............ Lot Size ...................... ..... ........... ... Water Supply: Public System and name .......................................................__. .................................................Private UJ Character of soil to a depth of 3 feet: Sand❑ ❑ Clay r] aPeat❑ Sandy Loam 0 Clay Loam ❑ Hardpan Adobe-❑ Fill Material ----........ If yes,type............... ............ {Plot plan, showing size of lot, location of system in relation to wells, bui#dings, etc, must be placed on reverse slde.[ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is"available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I] Size............................ ....... Liquid. Depth .......................... Capacity .. ................. Type .........----....... Material.._................. No. Compartments .... ......� f . Distance.to nearest: Well .................................::.Foundation ...................... Prop. Line ...................... LEACHING LINE [ J No. of Lines ------_----------- Length of each line.......................•.... Total Length ............................ D' Bax Type falter Material ...Depth .Filter Material 5. Distance to nearest: Well ........................ Foundation ... Property line SEEPAGE PIT j I Depth .----:L------------- Diameter ..--............ Number--....---__...... ......... Rock filled Yes ❑ No Q Water Table Depth Rocle Size .... Distance to nearest: Well ---•....................................Iwo ndation ._._........:....... Prop. Lino ................... f L REPAIR/ADDITION(Prev. Sanitation.Permit# .........---.--_.--........................._Date.......,....•......--................) Septic Tank (Specify Requirements) ---- ---------•--- .................................................._............................................_.......................... Dis 0601 Field (Specify Requiremen_ts) .... . ... ..... ... ---.. --- ----- --.... .... ..... ...... --... . # �b Zits-- a� ...... t' ....--. .......= ere� ---------------- .................................... ...•---- l(Draw existing and.reqaddition on reverse side) I hereby certlfy that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Hence owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shalt not employ any person in such manner as to become s6blect to Workman's Compensation .laws of California." Signed -•-• -------= ----- . ......... Owner Title - (lf other than owner) -. FGR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - : -- DATE BUILDINGPERMIT ISSUED - ----- -------....................... .......... ------------------- ----------------------- _DATE ......... .................. ADDITIONALCOMMENTS -------- ----------• ............................................................:._.._-..._......-....... ................................ :- ----------- ----------• -------------•----•--------...-------••----------------- ---------•----------.---- ---- ....................... ---•----------------••----......._...._.. by Finaf Inspection : ----- ------------------------------------------------------- pby: ............ ........................•.....................................Date ........ ...-.....---• --------- ET1 13 24 1-68 Rev. 5m 'i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M F