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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �' .................. ... (Complete in Triplicate) ........................................... ......... b `:....:.:............. This Permit Expires ] hear from Date Issued ate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: � ........ ...... ............................ clNsus TRACT ••• ....................... JOB ADDRESS/LOCA N ................ i Owner's Name _.. __. .. . ...-.�_ •��.. . ...................................................... ................. •-�• Phone Address '. .__........ ........ ......... = -.... City _.. Contractor's Name --.License 94` ........................ Phone Installation will serve: Residence[j Apartment House f] Commercial Court 0 Motel ❑Other i Number of living units-1 Number of bedrooms ......Garbo e Grinder ._. Lot Size tr'e................ Water Supply: Public System and name 1� `1 -Q ....................................................Private [:1 Character of soil to a depth of 3 feet: . Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan❑ . Adobe 0 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.) NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,! l/ _-__. Liquid Depth ... .-.." .......... PACKAGE TREATMENT € ] SEPTIC TANK Sia ................................... I Capacity��iy�(! Ty i._"'�_apterlMla! o. Compartments .._...�per1 z Distance to nearest: Well .. v.......................Foundation .. ............. Prop. Line ..........-.0 LEACHING LINE [ ` No. of Lines .-` -•-----_-------- Length o each line..• _C- .�----'•-• Total Length ...��.? �. _ pr .... 'D' Box .� . Type Filter Materia .... .............. ep ter Material ... ...... - Distance to nearest: Well Foundation --• ........... Property Line ........................� SEEPAGE PIT [ J Depth ......... ---------. Diameter _}:.E:._......._ Number ......... Rock Filled Yes-0 No (]p' Water Table'Depth ..................:----_ ..hock Size.-.. ....__. Distance to nearest: Well ; __....Foundation '.. .. Prop. Lina REPAIR/ADDITION(Prev. Sanitation Permit# ........ -• `.-...•-- -------- Date ----------------------------------1 I ----------------------- .....--....-•••••. Septic Tank (Specify Requirements). �' � Disposal Field (Specify Requirements) ---------------•:• ... -----•--•----------------------------- -------- -----•---...------....----•----•-----................--------•--...---•--•-----------._......--••---- ........ -------- ---- - - (Draw,existing and required addition on reverse side) I hereby certify that 1 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. Home owner or licen- red agents signature certifies the following: J "1 certify that in the performance of the work far which this permit is issued,-1 shall not employ any..person la such manner as to beta a Ubject to orkman's Compensation laws of California:" .. -•-` '' Signed _ Owner" By . --" _..:_:� _;_= - Title ------ --------------------- ................ (If other than owner) x i FDEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._... ... ........... DATE _.._`. .77 ---- BUILDINGPERMIT ISSUED ------------------------------- ----------------------- ---•-------------- --.......................---DATE --------------------- ------------------ ADDITIONALCOMMENTS --------------------••---------- ................... _._........----------------.._....................... ------ -----------•---------- --•---- --------------------------------------------•---------------------------------------- { ----------------- __......---.._. ....... -----------•--- ------- •-------------- ---------•- ...... . ---•...................--•---...-•---- ---------------------------------- ------------------------------�SANeJOAQUIN - --•-- Finai Inspection by: . .. ............:.......Date ... ._.�. �... .......... EH 13 24 1-611 Rev. 5M T LGCA�TH DISTRICT 8/74 3M