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FOR OFFICE USE: FOR SANITATION PERMIT APPLICATION �- Permit No. _...-........ (Complete in Triplicate! _ . - . — - • .........:. -. .................I——........_ .................. i /��.� C, Date Issued .................... This Permit Expires 1 Year from Dato Issued } Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .0-"7` _i!?. Q.d!-4--i...................................CENSUS TRACT ..........._..-...• - Phane ` -Z/.y Owner's Name ................................ . Address -......- �..: --• - ..---•- •-»-__-...-._..City ............ r r Phone .._ Contractor's Name -- .. -.. -- .__.License #' .._..._._;.............. ,.�_�. .. Installation will serve: Residence KApartment House] Commercial❑Traller Court r] Motel O Other Number of living units:..... Number of bedrooms Garbo e Grinder Lot Size .................... Water Supply: Public System and name ..........................................----•.................. ............................Private -----.. Character of soil to a depth of 3 feet: Sand t} Slit❑ Clay ❑ Peat❑ Sandy Loam fl -Clay Loam Hardpan 0, AdobeFill Material ........_.-If yes,type (Plot plan, showing sire 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,} 46' . � PACKAGE TREATMENT [ ] SEPTIC TANK 1dr----•--•-----------•-••-_- Liquid Depth -5 ..��---•..._,..:__ Capacity. TYPE •_ . �o '-__-:Material_ -� No. Compartments .._ .............6 ��- ©L- L Distance to nearest: Well -._ ._ •_ /D_0© __Foundation ..-�- ........ Prop. Line .4.•'`•---••-� r' �-�� LEACHING LINE No. of Lines ----- ------- Length of each line----. ..-Q- --.... Total Length .......... 'D' Box -.... Type Filter Material _-- . .Depth .Filter Material _. ............................... C - , .0' d Distance to nearest: Well .�_ :�--- --. fou ation --- - -_ Property Line .-....... .. �. r -- � ... -_..-. SEEPAGE PIT Depth --____- Diameter R ....-- --•/ -•-•-t� Rock� ed Yes;� No ] =__-- Number_ �---- It. F—/ Water Table Depth _. .c�__ �” ock Size •...-••••-•••- Distance to nearest: Well ---1.0-0--. Foundation .......... _-.-_._ Prop. Line ................. - REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Da#e •..................•--._..........� uirements} p Y Requirements) r -•-------••---•--••••---------------------- ..............__- .. ..-------------...-- Septic TankSecif e Disposal field (Specify Requirements# #.----------- ------------------------------ ----------- ---••-- ---•--...----------.....••.... .......................................... --------------------------•------•--------_--------_I.................................................. (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 local Health:Dlstrict. Home owner or licen- 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 bac me sub*ect t kman's CompeFan law: o California." Signed s.i a- , � C er— ---••----By ------------------------------------------------------ ---- ------ .-_ Title (If other than owner) I FOR DEPARTMENT-USE ONLY - APPLICATION ACCEPTED,BY ____-- - .--------- DA7E •--• G .. BUILDING PERMIT ISSUED DATE -. ADDITIONAL COMMENTS -•--- --- -- --- --- -------- -- Date �. ...---- 3 Final Inspection b -" -' � ' -"`---- - EH 13 2b 1-68 lay. SAN JOAQ I LOCAL HEALT DISTRICT 8/74 3M