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H FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 11Comp ? e in Triplicate) Permit No. %-Z-�?- �- �f fH '•. C Date Issues! i.... ............... .... ........ This Permit Expires 3 Year From bate 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 'in compliance with County Ordinance No. 5&nd exis ing Rules and Regulations: JOB ADDRESS/IOCATIC)N .-"�"i..+7!5. cJc.��.. .. iNi3TRACT -............ ............. Owner's Name. ..11.._.,...._....... _............ .... Phone .. _ ............... ____ ....... Address ................... City...... Contractor's Nar.. .,j._.._ - �Y..x..i...e .t»y ... license # ._.....- Phone ._. l._._ _ . .........__......... Installotion will serve: Residence partrnent HouseCommercial OTraller Court 0 Motel rl Other_,. .................................... ... .. // C l.a Number of living units:..._7..... Number of bedrooms ....._Garbage Grinder .......... � lot Size .... ........................r....._. Water Supply: Public System and name ....................... ...... __................_.. ........ Character of soil to a depth of 3 feet: Sand 0 Silt Clay n Peat Sandy,Loam 0 Clay- Loam F I Hardpan ❑ Adobe Fill Material If yes, type ...............•..._.._..... (Plot plan, 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,} qq PACKAGE TREATMENT r 1 SEPTIC TAN Size.. Liquid Depth .... ................ �i Capacity ..................._ Type _... ...... Mnteriai....,...,_..._.._....: No. Compartments ................... Distance to nearest: Well ........ ........... ................. Foundation prop. Lima .............. .... , LEACHING ZINE [ j No. of lines ....................... Length of etch line._,.._ .l Total Length . .......... t} D' Box . Type Filter Material Depth Filter Mot*riol ...... ......... ......_.. W.... � Distance to nearest: Well Foundation Property Line ........... .......... l SEEPAGE PIT ? Depth Diameter � Number Rock Filled Yes fl No �j � .� Mater Table Depth' _...,...._.._..._.......... Rock Size_..._.4......................... ,. —.Distance to nearesf-Well . ............ _.. _ ._Foundation _.. ......._ Prop. .................. REPAIR/ADDITION {Prov. Sanittrtiin Permit # ........ ......... ...... Date ,...... ........) Septic Tank (Specify Requiremenysl.. - ••. .. - . _ __............... ......................... .... ....., Disposal Field (Specify R wire eras} .....,_ � { pec-fy ' (Draw existing and required addition on reverse side) I hereby certify that l have prepared this applicatlon and that the work will be dar* la accordance with Satz Joaquin County Ordinances, Stater laws, and Rules and Regulations of the San Joaquin Laced Health District. Home owner or,licen- sad agents signature certifies the following: "I certify that in the performance of the work ferr which this permit is issued, t shall not employ any person in such manner cis to be blest to Workm 's C pansation la of California." Sine..._ A� `� Owner ,. By ............... �.a,. ...... title ......... .......... �L. _ _ .................... ._......................., ..._.__. {!f other than owner) 1 x FOR D£PAR MEIVT 115E ONLY � � __.._ APPLICATION ACCEPTED BY i+i!-,.._. .... ._.................... 3 BUILDING PERMIT ISSUED ....... ....................... . ..DATE ... ......... ..._.......... ............ ._.._.: 1 ADDITIONAL COMMENTS .. ................._....,........,.._.._._-........................- _.._ w ............ ....... ...... _ .. _ ................. ------ r • final inspection by., . ... . _.------ SAN --SAN JOAQUIN LOCAL HEALTH DISTRICT � £. H. 9 1 -`68 Rev. 5M