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FOR OFFICE USE: A APPLICATION FOR SANITATION PERMIT // ....... ............. .......... ... : �- Permit No. .2-5/7 .S74f (Complete in Triplicate) "' ' .:.........------....................... ------------- This permit Expires 1 Year From Date Issued Date Issued ... ..7��.:�.... 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: JOB ADDRESS/LOCA ON ._ t?'. .::.. ....CENSUS TRACT .: .............. Owner's Name ....... ............ .... -- ,..... ................................Phone,..--••---•---- •---•-•--•----- Address 9 _s.� .... city Contractor's No _._...__.�-- - ---------- - - -- ------- ----=--•.._....---•--•-- •-----_. icense #+ - xJ.22 Phone .3 �........_--•_.. �..—C/G } Installation will served Residence 0 Apartment Hou e0 Co merciai []Trailer Court 0 � ] t... �. Motel 00 .:. :. _!bac-/: �'7 ............ Number of living uni?s ...... Number of bed s ..4�...-�Garba a Grinder -! 0_.... Lot Size _ !t:!d�''r!!_. �/✓�!ip� Jt Water Supply: Publ is System and name ...._'---- -•--. lN� -----.-- .................. .......... Private Q Character of soil to a depth of 3 feet: Sand ] Silt Clay -Peat Q Sandy Loom fl Clay Loam Hardpan C] Adobe 914111 Material /V.. If yes,type ............................ (Plot pian, 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,) [ 7 e...... ................... Liquid Depth .. f......,..... PACKAGE TREATMENT SEPTI}C TANK Si Capacity / Type /},G-.L;< Material.- ;du o. Compartments ...... Distance to nearest: Well �t ............. .Foundation .../k.. ......... Prop. Line . LEACHING LINE No. of Lines .......�........:..... Len th of each line---- ..U4_1.j:...___._. Total length lee-1....._....... 'D' Box '-�..._ Type Filter Material f.?[, '......Depth Filter Material ...J{�_. ....--•.......................•� { Distance to nearest: Well �., 4....... Foundation ..... D Property Line .................... SEEPAGE --••••--.........-.. SEEPAGE PIT [ I Depth ..QUA ......... Diameter 4,4-..`.•_-.. Number _..._...-�--------- -------- Rock Filled Yes �'liio p 0 i I ' Water Table'Depth -_ 4_ ._...Rock Size --4&_ . ...... _....._..1 � .Foundation O f_...._ Prop. Line _�..._ Distance to nearest: Well - -- _ - -----•................ ---.�---- _.._-•--- REPAIR/ADDITION(Prev. Sanitation Permit# ................ .................. ... Date _--_----A Septic Tank (Specify Requirements}.. .....................:. :................_....-•--••-••---......----•--•---• ............ ...................... Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------- -------- '^ter+_'• -w: -yr k __..._...._..............._.__.....____.._!_............._..............___________......................._........------------------------------------------------------......................--_--_---_- ..........................................:........... ................i..._.__._._.........__..............w...___._____.........................______.._-___-.-_-__-_._.................._....._...... , (Draw 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 San Joaquin County Ordinances, State-Law-s;dtid�Rul s and-Reguldtions of'the'San"Joaquin Local Health District. Home owner or [Icon- sed agents signature certifies the following: "1 certify that in theperformance of tke"work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .`:_'`-.... -------•....................... Owner , By .................. _4 . ......................................... •...................... title .. . o er than owner) !` ti FOR DEPARTMENT USE ONLY Of APPLICATION ACCEPTED BY ... = •--- ... DATE ..�`� .. .. BUILDING PERMIT. ISSUED ------ -------------------------------------------.......- -----..........................................DATE ............................................ ADDITIONAL COMMENTS ................. .............................................:........................... .......................... -. :_-- . ..............._.- _ .... ....� . . ----------•- ..... _ Final Inspection by: ...... ...... ..... .. .. .... .:. - ------- •--• ----..........----.Date . ....... ............. .......... SAN JOAQUIN AOCAL' EALTH DISTRICT E_ 14_13 24 1.'AB Rev_ 5M 7/72 3 M