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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................................... Permit No. . {Complete in Triplicate) .................................................. _ _ . r s Dare Issued g= 5�s ' This Perntit Expires t Year From Date 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 inn 7compliance with County Ordinance Na. 49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...1.. ...cfi. .. .. . .CENSUS TRACT Owner's Name ... �1... ...............:.............................................................Phone .................................... Address ..... 97 � -. �.1 ......_.....City /� Contractor's"Name --- .......................License i �:�f. J� Phone j. . t 77 Installation will serve: Residence.0 Apartment House Q Commercial QTraller Court Q Motel j]Other......:..................................... Number of living. units:..:. ..... Number of bedrooms .L,,1?�.....Garbaga Grinder ............ of Size ,2.�. .:;; ... Water Supply. Public System and name .................................................... ..._..........-.�. ..........................Private,( ' ,r Character of soil to a depth of 3 feet: . Sand j] Slit Q Clay 0J Peat Q . Sandy Lodm Q Clay Loam Q Hardpan Adobe 0 Fill Material ..-:_....... If yes,type. ............. ............ (Plot plan, showing size 1,64 lot, location of system In relation to wells, buildings, etc, must bike p`oW on reverse slde.) NEIN INSTALLATIONc jNo septic tank or seepage pit.permitted if public sewer is available within 240 feet,) . PACKAGE TREATMENT F31 SEPTIC TANK{ ]- Size. .r. .. .. ........... Liquid Depth . ...................% Capacity. Type , ... Material...................... No. Compartments ..................... N i Distance to nearest: Well . ....................-Foundation ..../.UU............ Prop. Line ,....d4E_0........ : � 0 LEACHING LINE No. of lines .... ....: Length of each line... i .............. Total Length .. . 'D Box .:._..---� ... �............ 'type Filter Material .........:..........Depth Filter Material ........... ...................... Distance.to nearest: Well .... . _.......... Foundation Property Line r�� SEEPAGE PIT { ] DeMpth � ��+Aiameter .; : Number ..... :........ Rock Filled Yea. ..No.. 0 ... Water Table Depth .................................,..............Rock Size ... J.' .......... '. Distance to nearest: Well ........................................Foundation .� .. Prop. Line REPAIR/ADDITION(Prev. Sanitation i Permlt# ......................... .... Date _... ........ ...... SepticTank (Specify Requirements)_-:............... .......................................................................................................................... 3 Disposal Field (Specify! Requirements) ..................................................... -•-••-•--•----..........._•----......_..-----------•-= •----•....------=--- i ........................-- •-------------------- - -------- -------- ------------•- .... _-........._._....._..._-...._.......' .• '..........--•----•..................... , ......_. -_----_ q (Draw existing and required addition on reverse side) I hereby certify that I hay 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.Glstrici. Home owner or Ilcan- sed agents signature certifies the following: r ,1 certify that in the performance of-the work foT wilier I isr-ppirmit #s issued, 1 shoill nat ensploy any person in such manner as to become subject to >fprkrnan's Compensation laws of California," . Signed --•- mfo; -_.I2o �ne' Owner !3y ........ ... .-. .. ... .........__ Title :.....__..._.... .....:............ r trj� FOR PARTMENT USE ONLY APPLICATION ACCEPTED A. :/�:c .......... BUILDING PERMIT ISSUEDI�.....:.. ..... ...._:......... ... ...._ DATE ...................................... ..._. :.ADDITIONAL COMMENTS I... '�f .._... . . ........------- �__-_... .---------•...__.....__...-----....._............_............._. ........__......._.._.__...._..............---................................................ --........................... ...........:.. ................................................................................................... .............. ....................... ....... ................... Date ,../ EH 13 21a 1-6 E3 ftev.�� 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M ,19