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FOR OFFICE USE: I ------ APPLICATION FOR SANITATION PERMIT ............................... Permit No. {Complete In Triplicate) This Permit Expires ] Year From Date Issued Date Issued ..................•. ..................................................... k Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in complian a with County Ordinance No. 549 and existing Rules and Regulations: JOB.ADDRESS/LDC N .. .............................................CENSUS TRACT ....................... Owner's Name - .-. .,. 1 -----....... .....--•--.......... Phone . la. ..... �� Address . --.--- 3.yo {- �- ---- -- -------- •----....... ...._............._....._-crty .. --- -- --..... _. ...........................License # .�71,5;,.�.� Phone .. Contractor's Name ______r�4�...i�_...--: r -•- �, 3~ d: . Installation will serve: Residence 0 Apartment Hous fl Co m�❑Traller Court 0 Mate! [3 Other _. ------ ---- ------- .-- Number of living units•....,1 Number'of bedroom ""'s ....@Garbs a Grinder Lot Size Water Supply: Public System and name..........:.:..: Private I Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam t] Clay Loam I Hardpan ❑ Adobe t] FIH Material ...... if yes,type ............... ............ o- (Plot plan, showing size•of lot, location of system in relation to wells, buildings, etc, must be placed on reverse sidej NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 fest,) , PACKAGE TREATMENT .[ ]. SEPTICTANICI� ize....... )e 4`K •....._... Liquid Depth ..... ................... Capacity .lv� .__.. Type Material. ... Na. Compartments ...... Distance. to nearest: Well ___ .................Foundation .� ------ Prop. Line 5 �. LEACHING LINE No. of Lines 2...----__ --- Length of each line.. .�.. ..........Total Length ......... "~'©` 'Box v Type Filter Material Depth Filter Material .... �.............. • pistance to nearest: Well _, ................ Foundation - ...�--....-...:... . Property Line SEEPAGE PIT [ ( Depth...................:.. Diameter .-�....._.----- Number ----------------------------- Rock Filled Yes ❑ No Q k Water .Table Depth--...............................................Rock Size .................. ............. �. Distance to nearest: Well ..........w........................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prey Sanitation Permit# -------------------------------- ...... Date -------------...._.--------------- Septic Tank (Specify Requirements) -------------•---...._....................-----............_..------.........---•••..._..._...... Disposal Field (Specify Requirementt - ..... Requirements) -----.............---------•. ---------------------------------------------------------------------•----------- •--•----------•• '-------------...............------------•-•--•---------.._.........._.....-----------..........-- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin a County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hoene owner or licen- sed agents signature certifies the following: "1 certify that In the performance of the work for'which this permit is issued, 1 shall not employ any person in such manner- as to becsub ct to W an s mpensation laws of California." Signed = r Owner By --------------------------------------- Title ----- lif other than owner) RTM T YSFO,OILY APPLICATION ACCEPTED B --------- --- ------ :..._.._.. DATE ...��. z 7------- _ BUILDING PERMIT ISSUED _._._.... .. -----------------------------------------•--.:_..---• ---------------------------------DATE -------------•-•• •------..._.....------=-.. ADDITIONAL COMMENTS .. -- ------------------------------- ------------------------------- --------•--------- -------------------- --------------------- ----------------------- --------...--•. ........... Final Inspection by-. --- .... ...-------•--.-••.......................Date -.a.' ---- .................'...... EH 13 24 1-613 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M - W�