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r� FOR OFFICE USE: APPLICATION F*�R SANITATION PERMIT Permit No. ...�..3.:.�.... (Complete in Triplicate) Data Issued . This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wont heroic, described. This application is made in complion a with County Ordinance No. 549 and existing Rules and Regulatiarae 147 JC`6 ADDRESS/LOCATIU � �.lo._. ..CENSUS TRACT .......................... , Owner's Name s/'J/' �..... ........................................ Phone ............................ k. Address _.�$ 3 ��.,.....-_... -.-.. .....City . ......._. _. ppa . / ..& cam. -- Phone Contractor's Name ..License� .�,/ �r ....................»_--'--•. , Installation will serve: Residence t Apartment Houseommerclal railer Court 0 - o , Motel ❑Other . Number of living units. --- Number of bedrooms -Garbog a &Inder ............ lot Size ........�........... •--••••--• Water Supply: Public System and name ........_........._............... ............. ....._....................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam (i Clay loam❑ Hardpan G Adobe ❑ Fill Material ............ If yes,type............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side•) 4A NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,l op W .: PACKAGE TREATMENT [ ] SEPTIC TANK Size-- .... .../..... ....• ••• • liquid Depth ..... �J Capacity 1.�-66�1�KTypt No. Compartments .A;k%......opr .. Distance to nearest: Well ........-0.....................Foundation .......��......... Prop.line...... LEACHING LINE No. of Lines ....... ... Length of each line ..... 5�.3?. 9 b �. Total Le .... 'D' Box .."—.. Type Filter Material .....�....R..Depth Filter Material .......... ; Distance to nearest, Well .......vO P . Foundation .......Z-0......... Property line ..... ......._... SEEPAGE PIT [ Depth Diameter Number I j Rock Fi�ed Yes No Q Water Table Depth div..'...................Rock S(zs ...�/.�.Ni ., .....• ;. Distance to nearest:Well ...........&Cl'�..............Foundation .. ... Prop. Line ......., .........� REPAIR/ADDITION(Prev. Sanitation Permit tF ............. .............................. Date ..................................I SepticTank (Specify Requirements) .... .........................................................................................._............._.............. DisposalField (Specify Requirements) ..................................................................................................................................... di x y . ............_............................................................................................ (Draw existing and required addition on reverse side) ! I hereby certify that I have prepared this application and that the work will be done In accordance with San Jeagvtn County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or iicets- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit Is issued, 1 shall net employ any person IM sveh WAMW as to become subject to Workman's Compensation laws of California." t Signed .. . ... ....._. `... . ...... ............. ................. Owner `` ........... Y......... .�'. By ... ....... . ....j.... i Title ..... ................7_............................... If other than owner n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . !!............................................................ DATE A..-*0-772.................. BUILDINGPERMIT ISSUED ......................................................................................................DATE........................................... . ADDITIONALCOMMENTS .......................................................................................................................................................... , .................. ............................................... ...... ................................ ...................... .................................................................... a .......................................................................................................................................................................................................... ........................... �+ ,, FinalInspection by: .r ..xa�R�.A . ....................................................................Dafe, ... ............................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M