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FOR OFMCE US& Ppucwrm FOR SANITA-nON PSWIT ti (Complete in Triplicate) -This Permit Expires I Year From Bate Issued f.4irmlt. No. 4W -1,0,o,6 Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ord r once No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ................. CENSUS TRACT ........ Owner's Name ... ...... Phone . Address . .... . ........... 40�:/ ..... ........ city Contractor's Name _... ...... ....:..._._.License ----- - Phone ....... �,O "2— Installation will serve.. Residence F1 j Apartment Housed Commercial CTrailer Court Se,, Motel M Other _. .......... ........ Number of living units:,..... Number of bedrooms .... /...-.,Garbage Grinder Lot Size Water Supply-, Public System and name .. Private Character of soil to a depth of 3 feet: Sand F] Silt M Clay Peat E] Sandy Loom Cloy Loam 0 Hardpan n Adobe Fill material If yes, type .......... - - ------- . .......... JPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse Ak.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4_1 PACKAGE TREATMENT I I SEPTIC TANK X Size.._.,4�X-J.7X_'.?_ ... . Liquid Depth V ...... Capacity /-::t'ZType _&440*4 Material__ ... No. Compartments Distance to nearest: Well ........ ..-Foundation Prop, Line . ... L�... t7_1 LEACHING LINE J Na. of Lines ......... Length of each line...._MA _ - _ _ Total Length `D' Box Type Filter Material -ry.&Atokbepth filter Material I......."If ............. ... . ... P -�-_ Foundation Property Line Distance to nearest: Well SEEPAGE PIT i Depth ... .... ... .. ... Diameter ... Number Yes 0 No C3 ...... .. . ........ Rock Filled C Water Table Depth _ .............__........,...................Rock Size _.. .................... Distance to nearest: Well ..............................,..........foundation ..... Prop. Line ........ REPAIR/ADDITION (Prev. Sanitation Permit# ... ...... .......... . .......... Date ....... - - - --------- ----------- ) Septic Tank (Specify Requirements) ...... ........ ....... ........ ------- Disposal Field (Specify Requirements) . ........... ................ . ............... ................. ....... . ..... . .... . ............... ...... ........... - ...... ......... __ .......--_-._.....•------._...................... ........ (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 Laws, and Rules and Regulations of the Son Joaquin Local Health District. Horne owner or licon- sod agents signature certifies the following: "I certify that i the p an 'i4formonce of the work for which this permit is issued, I shall not employ any person in such m not as to becolpe ubjecy� Workman' C mpensg4lon law of California." Signed V?(/ 7,17 ........ Owner By... ..... ....... . . ............. Title (If other than owner) FOR DEPARTMENT USE ONLY ....... .. APPLICATION ACCEPTED ....................... ........ * ........ * ....... * ..... . ... . DATE ..... BUILDING PERMIT ISSUED ........... ........... ADDITIONAL COMMENTS....- . ..... ....... ___ ----- - ...... . ............. ....._..:.._I......,....---............. .... ............................. — - ----------- ...... ... . ... ____.._._ ........ ......... ........ StN, OAQUIN LOCAL HEALTH DISTRICT D( ------------- y: ........ N -- ---------- - ------ ------ .................... ................ .... Final Inspection b ............... E. H. 9 1 -'68 Rev. 5M