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FOR OFFICE USE--...,-' K``• A •T APPLICATION_FOR SANITATION PERMIT dol (Complete in Triplicate) ` Permit No: .L�.��V. " This Permit Expires I Year From Date Issued Date Issued .. Application is hereby made to the San Joaquin Local HealDistrict for per it to construct and install the work hereini described. This application is made in comp!'an h a 549 and existing Rules and Regulations: Jif ./ JOB ADDRESSAOCATION . £.rrQ_...__. : ._�.t:?._.(�.I._..-.� __!✓..Jv.. CENS�_.. _ ,..�I �l Owner's Name .- -- - -- >�i. n,.... . - = .._.Phone -------- : ........... Address -• 7' =.--t----_------ -- - .--•+✓1 .� _..City .� ' t . _.._.....•... License# _f �;_I�-,�s: Phone . � � Contractor's Name - . --- • ...... 7 Installation will serve: Residence artment House-0 Commercial:❑Trailer Court i❑ Motet❑Other --------- Number of living units:..... _.... Number of bedrooms.-__.-Garbage Grinder/G-E--_- Lot Size Water Supply: Public System and name . ---•-----------------•-•----•-----------......'-----------------.._..------.........._.... ..................Private Character of soil to a depth of 3 feet: Sand o Silt o Clay ❑ Peat❑ Sandy Loam ❑ Clay.Loam,j] - 4 Hardpan ❑ Adobe r I Material oe.110 If yes,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 SEPTIC TANK Sizef.�"_.....-.____ .. Liquid Depth -__-__.----• Capacity !'Material.W2)1±`_i)dd No. Compartments ..��r—�..._...... Distance to!nearest: Well .._.__-,�" ...................Foundation -- .. . .......... Prop. Line.. J......... 4 LEACHING LINE (1y No. of Lines ... •:.. Length of each line.. Total Length ...•...... D' Box _.: _ Type Filter Material ..........Depth Filter,Materiaf .............�..._......-- Distance fo nearest: Well ... .............. Foundation�.: ............. Property Line. .:-..•.__...:._.. SEEPAGE PIT [ Depth .. --J--_ Diameter -��__.. Number ...^ ................... Rock Filled Yes Mj"igo t� Water Table Depth ................-- - -,5 .......................Rock Size Distance to nearest: Well ...__. .....................Foundation-.�:D._.�....... Prop. Line `��—....._........... REPAIR/ADDtT10N{Prev, Sanitation Permit# ..___.._.._................................. Date 1_.................... } Septic Tank (Specify Requirements) ----------------- ------------•--------•-----•---"I. -- ------• =........ r Disposal Field {Specify Requirements} ----•------,--.......................... •-----.•--•................•-_-._........---.-.-.---.-•--.-........--- 3 ----------.....................................................................------l.__.__....__._.............._.. --------- ........................_.........___..................... = !!n existing and required addition on reverse- side} I hereby certify that I have prepared. this application and that the work^will be dons in accordance with San .loaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin LocalHealth 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, I shall not employ any person in such manner J as to become subject to Workman's Compensation laws of California." Signed ------- .............. -------------••• _ Owner- - - _ . By.......................... ----- �� ^ •-•--•---• Title ......01•'-S----1' .d...... ...................................... (If oth t an owner) _ FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY—l',9,4....... . . .. - - -----•--. ................................... DATE.- ---�•------------ BUILDING PERMIT PERMIT ISSUED --------------- .......------DATE ------------------------_- - ------- ----.--------•-_ ... r ADDITIONAL COMMENTS _..--... _......---..._..-----------..................... ............................ ------------------------.........—........... r - ------------------ ........................................-------------------------------------------------------.................................................. -------•------_------------------------ .. ---------------------•---._......._. ...... •-•--- ---••--••-----•-------- -----------------•--------•----------------•--------------------- --•----- ................................. € .....----•-•--•---•........ ....... •..... .---- -----------•--------_ _- •--•--- -- --•--------•• --------------------------------- :_ Final Inspection by: .. .... ...._..--•-----------••----••--....Date .....�.IJP -.ip . ....., SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.