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FOR OFFICt U5E: APPLICATION ICOR SANITATION PERMIT 7- S/� .................................................... (Complete in Trlpllcate) Permit No. .... ..... ....... ............... ....................... . ... Thls Permit Expires 1 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 1s made In compliance with County Ordinance No. 549 and existing Rules and Regulatlons: ,JOB ADDRESS/LOCATI .V.�... �—.. ......Aall.............I.........................CENSUS TRACT ....................�..... Owner's Name �... �,lt'rr/=• :........................................... ... ................ ...........-._Phone Address ...L. /. . .�... .- .........................City .. .......................................... Contractor's Contractor's Name ...............................................License1 d�� ... phone 5- .�D,j. Installation will � serve:�--•-•- '.Resnc�e�ipartment House Q Commercial Z}Traiter Court 0 Vii. ry Motel`[?-Other.............................................. r Number of living u`oitt::-.-----..... Number of bedroow i......Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ................................................. ....--....... .. ...Private er'? t Character of soilto a Be tie of 3 feet: Sand 0 Silt❑ Clay :Q : Peat l] Sandy Loam 0 . Clay Loam [3 � Hardpan t3 Adobe❑ Fill Material ............ If yes,type I I )Plot plan, showing size of lot, location of system to relation to wells, buildings, etc. must be placed on reverse ,side.) . NEW INSTALLATION: : lNo septic tank or seepage pit.permitted if public sewer is available within 200 feet,) I PACKAGE TREATMENT j SEPTIC TANK /J Size.... Liquid Depth Capacity wipe ---C ?:? Ma3erial................... No. Compartments _.. 'r......t1V r Distance to nearest: Well. � __..........=..._...Foundation l,I Prap. Line !44 11 i ........ -------------------- E LEACHING LINE No. of Lines ..,.1.................. g r r __._. Total length /e' i p [ I _. Length of each ;Itne..��J...-.---•--•- '� T 'Q' Box - -------- Type Filter Material --..Depth Filter Material :..,r .... ...................... ....... r 5 • , Distance-to nearest: Well ........................ Foundation ............ ........... Property Line SEEPS PIT D Depth. .................... Diameter .._ ......... Number ............................ Rock Filled Yee C] No Q Water Table Depth .Rock Size ' 49 Distance to nearest: Well ........................................Foundation _-.................. Prop. Line _.,.................._ '.: REPAIR/ADDITION{Prey. Sanitation Permit# ............................................ Date ......... .......................... } Septic Tank (Specify Requirements) ....................... .............. ..._................................ ..........................._....... .'.:... � Disposal Field (Specify Requirementsi ............ .............................................................. ---•----•-----.......... .............._.._.... .......-----.........................._..._.......................... .... ......-•.................•----..........._...--------•.....__.............---•--..................__........_----............._....-•---....._.............................. (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 Joaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or 411cen- sed agents signature certifies the following- "I-certify ollowing:"I-certify that in the performance of the work :for which this permit Is Issued, I shall not employ any person in such manner os to become subject t�kman's ompensatlon laws of California."'' !: Signed • :... ....... _ ._ . _ .............V..2 .... .._.._...... - . ............ . ......... By ................•--------................----•-----:..:...:................._..�.------.•--••------... title _ llf other than owner) -_ FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED 8Y ..................................:.......:DATE:67, _ 7.,.._....._,. BUILDING PERMIT ISSUED ----------------------DATE ............................_.....,........ ADDITIONAL COMMENTS ................ ............................................................... .:'............ .................................................................. ......................................J:................................................................................................ . ...................................................... .................. ............................................... ................................................I._.................... .... ............. ......_...-- ---............_.. .._.. .. ................_........... _ _ ..... � Final inspection by: ............. Date ��.7' .. JL.r.................. ....., ...... Iii 13 2h 1-60 Rev. _q4 SAN SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M a