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r FOR OFFICE USE: � . APPLICATION FOR S 4NITATION PERMIT ........... ........................ Permit No. 7 'Sr` `!. (Complete in Triplicate) ......... .................................. ........... �Y ......................................................... This Permit Expires 1 Year From Date issued Date Issued ...... ...;1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des ibed. Thi ap iication 's m de in compliance with County Ordinance No. 549 and�exdstring ! dRegulations: CS � / ftpJOB RESS L A ..�L.Y _.. TRACT .......................... Owner's Name .... ...... ------..Phone .................................... Address „ ., . ... t_ t ......... City �•- Contractor's Name . -----• -.....�.....:..... .:...............License #c�,�/��`... Phone 6 �-6 Installation will serve: Residence artment House❑ CoMmercial❑Troller Court Motel ❑Other,.............._............................ J Number of living units:.-.--/---- Number of bedrooms .�_3.......Garbage Grind" Lot Size .l.c_ a x ' Water Supply: Public System and name ......------------------------------------------------ ....... .................................................Private Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay ❑ Peat❑f Sandy Loam fl Clay Loam ❑ Hardpan ❑ Adobe ill Material ,ede-/d_ If yes,type ............................ (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) 1A NEW INSTALLATION: (No septic tank or seepage pit_permitte- _public sewer is available within 200 feet,) PACKAGE TREATMENT E ) SEPTIC TANK ize....`f �_ 7.. ___...__.__.._- Liquid Depth��:..... Capacity .-P-476-V... Type lL4 _ Material______ ___________ o. Compartments ...�............ Q Di a to nearest: Well ........... ..�. ..............Foundation ....I .. ....... Prop, line ....1 J_:f __... LEACHING LINE No. of Lines ......cam.._..._.. Length of ch line.-_..0 Total Length �/ D' Box __..Type Filter Material .1.�1. Depth Filter Material ./�I--��............................ -- _ tanc t�'o nearest: Well '_..60../ :.....: Foundation 1�.............. Property Line - -- --- -_-• � . SEEPAGE PIT [ Depth ___`��__._.. Diameter _�.��_ Number ...................�____.- Rock Filled Yes No ❑ Water Table Depth -.__------ /..2{, --- ------ Distance C,J��---........•------------------Rock Size . �.. -•--- _ Distance to nearest: Well . t�.-[..................Foundation ...�a..._`�-- Prop. Line �j___..__... REPAIR/ADDITION(Prey. Sanitation Permit 5 ..........................•-•-- ...._..._.. Date ......................•-••---•---•I SepticTank (Specify Requirements) ........... ....•-----•-•--•---•----------------------------....•...._--------•--•----..._..........._---...._......... DisposalField (Specify Requirements) --------------------------------------- ------------------- ------....................--------------------------------'-----------_.. ----- -------------------- ------------- -------------------------••------------------•--------------------------............._.........._....------- ....--- (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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Ham* owner or Iicen- , sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Work an's Compensation laws of California." Signed .................................... .. ..................... Owner G�`� ----•- Title .. ... _.... .. +► By ................................... _... (If other th ow r) FOR D PARTMENT USE ONLY ' APPLICATION ACCEPTED BY ................................. DATE .... _........ BUILDINGPERMIT ISSUED ............................................... l.._----- ......_.....-----------.._..---.............DATE _..__............... .................. ADDITIONALCOMMENTS ----..._.......................I...........I....---.......... .-.---.-. - ............ ................. .......••___._•_. .................. ..._.._....�.........-- -_-_---.. _•-•----___--------__-.---_•---•---------__••_--.-------- __ ------------------------------------------------------------------------------------------------ -- --- ----- Final Inspection by: .r. ��........................................................Date .......�....__. -' ....... SAN„ J.OAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 I-'68 Rev. 5M _ ,__ 7/723 ,14