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FOR OFFICE 4151" APPLICATION FOR SANITATION PERMIT 7C_�� • Permit No. ............... ......................................4............... (Complete in Tripllcatel ......................................................... .. _ y_ _-� _ Date issued E This permit Expires ] Year From Date issued s, -7 L E ..........I............................................ . 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, J08 ADDRESS/LOCATION 70 :. ............................:............,...CENSUS TRACT ....................,.... Owner's Name ............. ... ..... ......................................._ ..- ...................................Phone . ..�I.. Address ................__. i h.... ...........................................City •-• Z-7�1- Phone `J,S. .... .. . ._ . Contractor's Name .1.�•< ....License . Installation will serve, esidence(®`Apartment House Q Commercial[]Trailer Court 0 Motel❑Other...----------------------------------------- --.... .................... t Number of living units:-.---------- Number of bedrooms ............Garbage Grinder ............ Lot Size ............. -•� Water Supply: Public System and Iname ...................--------------•---...................._.................._..__...,...........__,.........Privets i Peat Q Sandy Loam❑ Clay Loom [3=K Character of soil to a depth of 3 feet; Sand n Silt❑ Clay Q Hardpan Q Adobe❑ Fill Material ............If yes,type....................... ... e a, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slds.1 NEW INSTALLATION% (No septic tank or seepage pit permitted if public sewer is avaHable within 200 feet,( -- PACKAGE TREATMENT ( ] SEPTIC TANK i ] Size................................................ Liquid Dept .:................... Capacity ....... Material...................... No. Compartments --................... --� Distance to nearest- Well ..Foundation ...... Prop. Line -----............... ' . Total length LEACHING LINE [ No. of Lines --- -----... Length of each line........................ ............................ 'D' Box` ....--•--. Tjjpe Filter Material ....................Depth Filter Material ............................................ Distancetonearest: Well ........ Foundation ......... Property line .:..................... t Number Rock FNled- Yes ❑ o SEEPAGE PIT [ ( Depth ... Diameter ......:......... , ................ Water Table Depth ............Rock Size ...................... ► - ..... Prop. line Distance to nearest, Well ------....Foundation ..............• .--.......-. REPAIR/ADDITION(Prev. Sanitation Permit ........................ ate .................••••.............1 Septic Tank (Specifyq ........... U�............................ - •-- ri ti: -�' Disposal Field (Spec) Requirements) ----- -� /l ..................................I.............-. ......_.._.__......__. .........__................................... �..: �------•--••-......:................... ... .... ------------------------------------ .............................................. ! . Draw existin and re uired addition on reverse side] 1 hereby certify that 1 have prepair Id this application and that the work will be do11 ns in accordance with San Jaaqu County Ordinances, State Laws.'and`Rules and Regulations of the San Joaquin Local Health District.. Notre owner or Been- sed agents signature certifies thei 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 bscom sub(act to Workman's Compensation laws of California." Signed �`%.... ._t:.............................-........................ Owner By ............................ ............................................. ...... Title .............................................................. (If other than owrie.. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - !... ...........,.... ... DATE .-.17-Y. 7.G....: BUILDING PERMIT ISSUED ........................DATE•: :: ......................................... :. ADDITIONAL COMMENTS ............................................................ .. . . ... ........ _... _._., Final inspection by• ..Date .. .-•-- ••-•--- - -- EH 13 2!t 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M . 1