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FOR OFFICE USE. - APPLICATION FOR SANITATION PERMIT Permit No. .:ZG- (Complete In Triplicate) .......... ...........------- ................. 4 Gate _2-_o7---__- ............] .............. ---- .. This Permit Expires I Year from Date 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 mod.6 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION ..............1.5.4.2 7._.E _M a..r s h....................................... .........CENSUS TRACT ..................... ... . ..... . Owner's Name ------------ A. E.ABrooks ..................................... ......... .. ...... ..................... ....... Address ---------------------------145.75 ...................City -Ga2t--_..... ......I.................................. Contractor's Name ... ....RotoRooter---S-ewer..Se.r..........................License # ..?I.�� -2616 .. .. . .. .... .. . .......... ... _3 .2....... Phone ..................... Installation will serve: Residence[Apartment House C] Commercial OTraller Court C] Motel 0 Other------•-•---=------•---._......._............ Number of living units:..._.._.. Number of bedrooms Garbae Grinder 3�2........ Lot Size 6.0..-x 60 Calif' ate.. Ser. ---- ..................... "T Water Supply: Public System and name _,.1........................................----------_.......................................I Private 0 Character of soil to a depth of 3 feet: Sand El Slit 0 Clay [3 Peat 0 Sandy Loarn 0 Clay Loom 0 Hardpan 0 Adobe 0 Fill M6terlal ............ If yes,type............... ............ (Plot plan, showing..size-of lot,-location-of-system €n relation to I 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,) PACKAGE TREATMENT SEPTIC TANK f Size-_----- ... Liquid Depth ........................... Capacity ----------------- ... Type -_---------------- Material...----•---•- --• No. Compartments ...................... Li Distance.to, nearest. Well ... ....... j ...................Foundation ...................... Prop. ine ..................... LEACHING LINE No. of Lines ........................ Length of each line............................ Total Length ............................ V Box ------------- Type filter Material ....................Depth Filter Material ........................................ Distance to nearest: Well......... ............... Foundation .......... ............. Property Line ........................ SEEPAGE PIT Depth --------i............. .Diameter ................. Number -_-----_------- ........ Rock Filled Yes 0 No (3 Water Table Depth ......... .....................................Rack Size ................................ Distance to nearest- Well ........................................Foundation .................... Prop. Line .................... REPAIR/ADDITION(Prev. Sdriltation 6rmit# ............ ................1—........... Date ....................................I Septic Tank (Specify!Requirements}........'add 1-4211 dia by...�5 _t -to exi tin ...sy -------- ................ .'....p . ........... ... ;�....... .................. Disposal Field (Specify Requirem' ents) ............._....................... .............. .... ...i................................ ..........I..........._. . -------------------- ---------- ----------------- ..........................................m------............. ................. .................... ....... --------------- -------------------•----'------------------------ - ----------- ------- -------------------------m----------........... .............. ....................... ................ ................ 4IN (Draw existing andregainedaddition on-reverse side)- I hereby certify that I have prepared this application and that the work will be done In accordance with San Joccluln-,;�.*., Horne County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Roe owner or lic66- sod.agents signature certifies the following: "I certify Wat in the performance of the work for which this permit Is Issued, I shall not employ any person in such manner as to become su ct to Workman's/Co pensation flaws of California." Workman's Signed ............. ....... ....... .. .. .................................. Owner BY -------------- -------- ................ --- Yitle _......_C_onbrac.tor............. ....... ........ --- ---------- -- ----------------------------- n it other thanowner-- ----------- -----I • FOJt DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------- -- ------ ---- ...... .................. --------- DATE ---------- BUILDING PERMIT ISSUED ...........1� ......... - ------------ -------- ------- --- *-----------------------------------------------------DATE --------------------------- ............. ADDITIONAL COMMENTS ............................................ ................................. ---------------- ----------------------I------------ -_----------------- .................. ........... ......... ....... -------- ....................................... ........ ---------------------- .............. ------------ ----- ..................................•------- ------ ---------------------------------- ---------------—-----------" ---------------------------------------------- ......... final Inspection by.. �_o ----- - .....Date�.�........................................ ---------------------------------------------------- I EH 13 2h 1-68 Qv 5'M SAN JOAQUIN LOCAL IHEALTH DISTRICT 8/7h 3M