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FOR OFFICE`-USE: APPLICATION FOR SANITATION PERMIT 73 -8G ( Permit. No. . ...... .. ....:...... ...... !' (Complete in Triplicate) ..................... Date Issued ........................................ This Permit Expires I Year From Date issued ___...� ~- work herein Application is hereby made to the San .Joaquin Local Health District for a permit to construct and install the described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: q 2, . Oj .. ...CENSUS TRACT ....... . .......... JOB ADDRESS/LOCATI N I Owner's Name .......k�-...... ..........Phone........... .. --•-•• Address ..` �.1;�... i. _.-.: City .............. I +!O Contractor s Name f t, ----- License T C ! e .. Ph Installation will serve: Residence ❑ Apartment Ho a C] Com martial ❑Trailer Court ❑ t Mvtel [j other . ................ j Number of living units:.---:-]... Numb6r. of rooms --- ..... a Grinder ..4r-- Lot Size ... Water Supply: Public System and name ..._, ------------------------------------ .1, .. Private ❑ Peat Sand Loam Clay Loam Character of soil to a depth of 3 feet: Sand❑ ilt❑ -Clay ❑ ❑ Y ❑ Hardpan E] . Adobe[]AF1`IT-Moterial!Z--'V---• If yes,type .............•-------------- (Plot plan, showing size of lot, location ofsystem in relation to wails, buildings, etc. must be placed on reverse)side.) NEW INSTALLATION: (No_septic tank,or, seepage ,flit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT , I ] SEPTIC TANK t I Size--------------- --------- ................ Liquid Depth .........1................ Capacity Material----•----- --• --- No. Compartments Q . Pro Line Distance to; nearest.• Well Foundation F „I -. LEACHING LINE [ � 1 No. of Lines ........................ length of each !E LEACHING Tota Lengt �!r . ...••--Depth Filter Material D' Box TypeFilter Material ... ......... earst: Nell .-....-- Foundation P ro a Line ._.-- Distance to:nI _F SEEPAGE PIT [ j Depth ...... ...........•••. Diameter .....___........ Number ----------- ............ 3 Rock Filled Yes C] I .::...............Rock Size Water Table Depth . --------•"'-----•-•-•- i Foundation Prop. Line ...-•.............:... Distance to,nearest:.Well——...._....-.. ----••••.. ..... I REPAIR/ADDITION(Prev. Sanitation, Permit�# pate .... ............................) i Septic Tank {Specify Requirements) ........................................................-------.... _... Disposal Field (Specify Requirements) . ' •/ ---- I ...- ---- 3�7 •----- �! ............Draw existing and required addition an.reverse side) I hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin County Ordinances, State Laws, and Rules"and Regulations of the San Joaquin Local Health District. Home owner or licew 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's Compensation laws of California." Signed ... ............ ...•---- = g . . Owner '~— Title -- Si . I 4lY-'- ""' (If of r than owner) ; FOR DEPARTMENT USE ONLY �o��++ ....... DATE .... .T APPLICATION ACCEPTED BY ............ -Ce. f BUILDING PERMIT ISSUED ................. ............ . - ....-..._ ADDITIONAL COMMENTS .. . ' •- .-- ------------------------------------ ---------------------- s ...._ .. .......... �. ------------------------------------•. .se.... -- •. Final Inspection by: Da SAN,JOAQUIN,LOCAL HEALTH DISTRICT._ _. 7172 3.,K _ .. � 2 94 .