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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT E� Permit No. :...................................................... (Complete in Triplicate) -. �jl:_�o•1T. ................ This Permit Expires f Year From Date Issued Date issued ..77-I .:7t� 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: JOB ADDRESS/LOCATION :. 6G.�-. ... r�-d .....:-P� . ---- --------------- ...........CENSUS TRACT Owner's Name r. ..... :. ...........--- ne Address .. o --------------------...............................••.... ......... City Contractor's Name. .- ... J ICC " ...-.. `�.� ..license # '� . Phone� ..-/ ... Installation will serve: Residence 0 Apartment House 0 Commercial ❑Trailer Court C] � Mote! ❑Other .. �uP f}e Grinder A_ v-dJi�1 . Lot Size .a�, � Number of living units:.--/...... Number of bedrooms .,V .-.Garbog - ...-- --• Water Supply: Public System and name .-..._._.•---- --------- ......Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loom ❑ Clay Loam ❑ f 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 ovaila�le within 200 feet,) PACKAGE TREATMENT { 2 SEPTIC TANK _.•• . Liquidp Capacity�� 7yp Mated No. Compartments �. Distance to nearest: Wel -? ..........-......Foundation .,,1 ............... Prop. Line :............t LEACHING LINE No. of Lines .. -. „ - - � ..-�-=•"-"----------- length of each 'line... Total Length ./fl............. D' Box ( .-- Type Filter Materia Q �----Depth Filter Material . ............................... :...� s ~' Distance to nearest: Well . Foundation ../.� .. .......-• Property Line .._� .. V v - � SEEPAGE PIT [� • Depth _-,5 .4-...... Diameter.._. Numiser ..--.---.J............... Rock Filled Yes Z' No (:1' Water Table Depth _.. ..----------•----•--- Rock-,Size / .�.�.,-. f} 1 Je ---- .11C Distance to nearest: Well .:_/4:00................ .......Founddtion ...4a......... Prop. Line ._-_5..........._°.Q 3 REPAIR/ADDITION{Prev. Sanitation Permit# --............................................ Date ................ `. Septic Tank (Specify Requirements) .................................. ------------------•--• {.. l Disposal Field (Specify Requirements) ------------- O ---------- ---------------------- - .........................................- ---------------- ....................... " 1. -^tip-- (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 San Joaquin Locat Ilcew , 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 become subject to Workman`XCompensatio laws of California."Signed .....:.:............•.••-----••---.-.-..... ......--•------- OwnerBy ........ .: ......................... ...... . Title ..(if other tha o er FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- ------- -- = ._ ... DATE -.. .......•••-•-....... • •--• BUILDING PERMIT ISSUED ..... ........................ ....... ................... DATE-:...:::.::..:: `== ................ ADDITIONAL COMMENTS •......................•-------- ............I........ •. • . --•---------------'• --•--••-- Final Inspection by: ......-. .. .............:.... ate . D -6 SAN PAQUIN LOCAL HEALTH DISTRICT (� E t{ 13 241-'68.Rev. 5M \ 7 f 77 1.K