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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit .............. . .--------- � . . .......... Triplicate) (Gonpfetein _ . . . __ .�.-.-a .77Date issued • _ - This Permit Expires 1 Year From Dow 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. 549 and existing Rules and Regulations: } y 1 ......... ......................CENSUS TRACT. . JOB ADDRESS/LOC Phone:. .............. h ......... ,........,...,.........._ Owner's Name - -- •��.. '--....... City ..� `'' ,............ ........... Address ............................. �` � -• .�Y93.�7-... Phone . �.. Contractor's Nome ..- .... �.�..••--/••..:..... .:...,License +� . installation will serve: Residence F Apartment Housefl Commercial{]Trailer Court (3 Motel ❑Other ............................................ i Number of living units.-..... Number of bedrooms „' .Garbage Grinder Lot Size -... "' .._........................:�..........:.'..... Private C Water Supply: Public System and name .---�........... ...................................... P e ` Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loa � ,Cay Loom Hardpan❑ Adobe ❑ Fill Material .If yes,type ............... .. .... . {Plat 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,) . A- �.. t PACKAGE TREATMENT ( I SEPTIC TANK{� - Size.. .. _. .._ ��............. Liquid Depth --�...............---� ��Ma#erial: No. Compartments ' •-•--......_.. r t Capacity �_ ±� Type Pro Line .. S� `.........Foundation .__.l�?. . .... p. .... W r :• Distance to nearest: Well ............... �" Total Length ...:�T� --.. -- LEACHING LINE No. of Lines ..._-_-_ Length of each line----.-`9.4? ........ . t� T r Material"- .De Depth Filte Mate al 3. Box .:_f:_ ... Type Filter Material ...S.�Z is L j-G?. _.. .._... Pra a Line ......�.. Distance to nearest- Well ...... . -- Foundation p rtY . Depth ---..._- Diameter .-- -------- Number --------------•--........... Rock Filled Yes ❑ No SEEPAGE PIT "I ( p Water 'fable Depth Rock Size .........................:.....: _.._. ..foundation .---. Prop. Line ..::....... G ' . Distance to nearest: Well ---------•------------------•---•- --• ..__......:.... 0 ----- Date ...........:......•-.....---.•-- ) REPAIR/ADDITION(Prev. Sanitation Permit a# ....----......---•----- ib Septic Tank (Specify Requirements).----------•------._...'.•---•-�...................................._............--------- -------------- ........... ...._ Disposal Field (Specify Requirements) ••. -------- .....................--..............-------------........... . i. --- -------- ------ .....................L 9° {Draw existing'and required addition on reverse side) I hereby certify that I have prepared this application and that the wark, will be dare in accordance with San Jeaquln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heahh.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 %hail not employ any person In such manner as to become subject to Workman's Compensation laws of California" Signed -------------=---------- ----------------------- Owner .............. litle (if other than owner) OR D P . TMENT USE=ONLY - ._ DATE ... :. .: APPLICATION ACCEPTED BY _._....._ - ._.. _. . _. .. _ 4 .....- --•.DATE -'- '.................................... BUILDING PERMIT-ISSUED -------------_------------ : ----------- --------- -------- •---------• -- ADDITIONAL COMMENTS ----------------------- -_-- ------_--- ------------•---- ------------------ __....:........._... •- --------- ................. ----------- •----------- -----:--- Y Date ..... a ......... Final Inspection b EH 13 24 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 314