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FOR OFFICE USE: fir- --� APPLICATION 1=0it SANITATION PERMIT ......... ••.........••. .................. Permit Na. lComplete In Triplicate) .... I.................•...........".:. ............ �� 7� This Permit Expires t Year from Daft Issued � Date Issued _�-•-•------...... 5 Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. This application is made in compliance w' h County Ordinance No. 549 and existing Rules and Regulations: !OB ADDRESS/LOC N // �fi� ? !a.L_ ... _... .. d..: -....:........CEIVSUS TRACT ------------_ - pp Owner's Name G ° ..... ...... .... .----..Phone Address ( :.� ?!i. ....Ci ilC.(� - - ............... ty - - Contractor's Name .....................L.ieense t2. .. . ..__ Phone � 1 "1��D`� installation will serve: Residence P ,Apartrnent House f3 Commercial OTrailer Court E Motel ❑Other...................... ---------...:........ Number of living units------1------ Number of bedrooms ___.J.....Garbage Grinder ............ Lot Size ......e2t-:-----------•------- r Water Supply: Public System and name .........................................................._.......--...............---.._-----_..._..._.......Private �,. - Character of soil to a depth of 3 feet: Sand'l] Silt 0 Clay 0 Peat❑ Sandy Loom 0 Clay Loam 0 Hardpan❑ Adobe$ Fill Material ............ If yes,type................ ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc.'n ust be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public-seweer-is avall ble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK .... :.. •.__'`.--_--` 4 Liquid Depth .IL51 ------------=� Capacity� 11 _-- 1cQ Type - -. ...__--- Material...Cp c� No, Compartments . _.::......Foundation .----1_.{?._f_-__--- Pro Line � Distdnce'•to�ne rest:-�V4Jel1".._.:._..:.. CTO.:_:_'_ LEACHING LINE No. of Lines..__._._.....__ Length of ach 11ner.._.. �.�......i_. Total Length ...1 a.1............. _-- Type Filter Material �.......... ...Depth F€Iter'Materiol` r 'D' Box ----- -- - r , j i Distance'to nearest:iWell ../�]/._.._...'__ Foundation -- /.0...1:....____. Property Line __ ................ SEEPAGE PIT ( Depth�..Z.Z✓___�__---. Diameter ._�17-.��..__ Number ----------�........__.. Rock tFilled Yes AQ No Q %i-'' Water Table Depth - ••-:--- ---_-............. --`.: -•--..._._ Rock size .*- ...---_-- f ..........__ s Distance to nearest: Well ------- ......................Foundat€on :In.. Prop. Line ..__ .............. ItEPAICt ADDITION Prev. Sanitation Permit # -------..----------------------------------- Date ._......__._.._--.____-____-....--.) SepticTank (Specify Requirements) .................. --------------------------------------------------------_......._..............................------------------ Disposal Field (Specify Requirements) -------------------•---_-"--__--_....-------•--------------.-------•---•- ----------------------------------- ............ - -----...f-;-- ------r------------------------------------------------------------------------s / (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done In accordance with Sar Joaquin County Ordinances, State taws, and Rules and Regulations of the Son Joaquin Local Health:District. Home owner or Ilcen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is'Issued, I shall not employ any person in such manner as to beco sukiec t Work an's mpensa n iaws of California:" Signed �.. ---•--- . . •--� - • ---- --.�......•__•--------- Owner By ------------- -------- ---- ---------- Title - ( her than owner) _ FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY ----- . ---------------------------------•------------------------------------ DATE ............... BUILDINGPERMIT ISSUED ------------ ......----------------------------------------..-••-------..._..------- --------- ----DATE .... _... ----------- ............ ADDITIONAL COMMENTS -------- -----•-•-•-.._...-•----•-----••--•----- ,.... - �- �-------- l --------- ----------;&7 ..........----------------------- --------------- ••--- -----------• •--•- � Final Inspection by: .------•-_ - ._------ •----------Date ... //.Y1z... .. .............. EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT / 8/74 3M C�