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FOR OFFICE USE: y rte' APPLICATION FOR SANITATION PKI IT (Complete in'Triplicate) t Permit No. ...... f ....................... This Permit Expires 1 Year/From Date Issued . ©ate Issued .. .......:........ Ap I' b made to the San Joaquin Local Health Districtfor a permit to construct and install the work herein {' scribed, Thi app Ica is made In compliance with County Ordinance No, 544 and existing Rules and Regulations: D TION h — � � � cr .�_ ..- ,.CENSUS TRACT E .:.......__.......__.. ._:. ._..lr .... ...... ..._ Owner's Name ................. ;--.+.v ........................................Phone _ -6�k?'.�-= .�:S�:...... Address .................... '�: _ti. _ .. . .......... ...........--•---.. .......... City ... ftii +ti,? 6�` ? .......--•-------............I........... - ....License # .��_.. Contractor's Nome ...... ! X �— . ..... ..... :.---- .�-:- -•--"---------1�:.........:................. ..,--`.r-�-----. Phone ----------------•............. 1. Installation will serve: Residence,[]Apar'tment House❑ Commercial ❑Troiler Court Motel;❑Other ...17!�Rj�`��... g s s ---Garbagel 4 - Lot Size .moi`:. :: 5..................... Y Number of living units::.:. . .:_. Number of bedrooms Grinder __ Water Supply. Public 5 stem and name ------ --------------•---------- - ............_.. . -------------. ..............................Private Character of soil to a depth of 3 feet:, !Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam Hardpan d Adobe [] Fill Material ------------ If yes.type ............................ (Plot plan, showing size of lot, location of. system L:in relation to wells, buildings, etc. must be placed on reveise side.) �1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMt:NT [ ) SEPTIC TANK f Size..AZP,:> ��?-D ----.----• ------------ Liquid Depth `` �,-•-.-- cy y ^* ._ Material.�'� a No. Compartments C11..................is Capacity �__._ .. Tye ��'� � ..-._ w J 'r`- Distance to nearest: Well -•---�'.-..--.�..,-.:•...............Foundat' n ..'��'r`"�..._... _-- Prop. Line .-� ...... C7 LEACHING LINE No. of Lines " } ; { 4�Aa& 6Y [ If" Length of each line-_-�._ __.... Totali length ....... t D' Box ---------- IType Filter Material .-•-........_........Depth Filter Material .__-...................................... Distance to nearest: Well .........................Foundation Property Line # Crrnw„r nor. F , �6RAGE-PIT Depth .../cr.'.......... Diameter K.Z___ Number ... ---------------- Rock Filled Yes 15 . No.C] s� -- Water Table Depth !? .. ...Rock Size.-..�.f:_'__.�-__. i Distance to nearest: Well `� `� ' ..._��+�'?.`.'�� ._ '_Foundation �� ......._ Prop. Line .••�._. p, REPAIR/ADDITION(Prev. Sanitation Permit f# ...................---------------------------------- Date ..................................y SepticTank (Specify Requirements) ----------------- ....................................•............:...................._......................._...................... Disposal Field (Specify Requirements) ! ---------------------------------------------•-••-- ..-•---....... ------ ----•------------------------ ---------------------------------__..------ ----- . -------- :...._._...:. --------- ....---------•-.........'..-••-••......-•--••---•---••-••- (DWW existing;and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be stone in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . .. ..............:... ._ Owner .. By ................ f _ . . i},1~. ._._...... . Title - --- .....................................•. ---------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... _. _..__ ------I——................................. ------------- DATE ----- . .............. BUILDING PERMIT ISSUED .................DATE ......:.....:.............,................. ADDITIONALCOMMENTS ...............---...._..-------•---._........---------------------------• -•---- ........... ..............................................................................................................................:..........:....................................................... ..... ......................................... ......_. ------------------•--------------------- - Final Inspection b • :'. .._Date ... p y: _._.._..... _... ..- -- SAN JOAQUIN -LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M