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FOR OFFICE USE: OPPLICATiON FOR SANITATION PEA ......................................I................ Permit 1GompiNe in Trlpllcah) Date Issued • ... This Permit Expires 1 Year From Date issued r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application Is made In compliance with County �Ordinance No. 549 and existing Rules and Regulatlons, JOB ADDRESSAOCATiO`N, .j....1 ..�J O.. '../�J� ..4 fF�f 1�.1�..- 1..'..CENSUS TRACT ........................:. Owner's Name7'�i' ............./..................../...,................._...................Phone Address . ...................................... !Ch11. ...........................................City ............................................................................ Contractor's Name .....................................D � ��............................License ..... Phone installation will serve, Residence❑Apartment House❑ Commercial❑Troller Court & 4 Motel❑Other............................................ s Number of living unitst.......i Number of bedrooms Garbage Grinder Lot Size .- _.. _......_ Water Supplyt Public System and name .................••••-•••---....................._......._..........................................Private Character of soil to a depth of 3 feet, Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam Hardpan❑ Adobe❑ Fill Mcterlal ............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 avpilabloswAln 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK X Size... X.64.. . squid Depth ...... .............� Capacity .t! Type fir.74 Materlal. t No. Compartments ..z'-........:.0 Distance to nearest, Well ......._ Q "....._......Foundation . � -.. Prop. Line 1 ....... b �............. Length of each 11it`....... Total Len th ..... LEACHING LINE � No. of lines ......... ng ne....:....,611 ..•0 'D' Box ...'.... Type Filter Material, Z. epth Fitter Material ...... ...7..... l.!?.. ..... .......� Distance to nearest, Well .....sV Foundat anj .....lid�it......... Property line ..... ............... SEEPAGE PIT Depth ..... Rock Filled Yes ❑ No ) ) p .................... Diameter ................ Number ....................... 'Pj Water Table Depth ............................................. Rock Size ......................... --- Distance to nearest, Well ..Foundation ...... Prop. Line IREPAiRMDDITION(Prov. Sanitation Permit qi# ............................................ Date ..................................I SepticTank (Specify Requirements) ..................... .......................................................... ........ ...j... .........�............... . Dlsoosal Fielci (Specify Requirement)) .• .�1`�� t • . S'1 ... ./y! ��/>"� ................. .................................................. (Dr 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 Son Jeaqul; County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcow sed agents signature certifies the following: "I certify #hot in tho performance of the work for which this permit Is issued, I shall not employ any person in such manner as to become subs ct to Workman's Compgnsallon laws of California." Signed ...........7WO. !�4�..f ''/r/nW................................... Owner By ....................................................................................................... 3itle ........................................................................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ................. DATE ....� 71 .......... BUILDING PERMIT ISSUED ............................................................................ .........DATE .:. .................................. ADDITIONALCOMMENTS ...... .........................................................•....................................:...... .................................................. {1` .........................................•---................................... .... .................... .. ..... . ......................... .................... .................... ................ .............. ...... .............. ........ ,�+ Final inspection by. .......................G.t ................................... .... ......I................ . ...............Date ... .................. #� `,iEll 13 2L 1-6fi Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M