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lR OFFICE USE. 3� . APPIiCAT10N FOR SANITATION PERMIT .. rtb�.►� ....: .�.............: ,. Permit No. _..... -. - S �O lWmplete In Triplicate) :... ..........................I.__. Date Issued _ .....................:....................••---•••I This Permit Expires II Year From Datelssued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein ! described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..._._....%:.�. __ A- .............. 17 l......._•.••--_...._.__•••................:CENSUS TRACT ..............._ ......_._ Owner's Name �, .•.... :.. ... ".. ..-..., ...._. Phone .-......._._..._._. ._... • /! P G Address ...................... ...__ .. �.- ' ....._.. ............. l --�-°•' ............................ - License Phoner - Contractor's Name Installation willserve: ouse❑ Commercial❑Trailer Court ❑ F 1� . Motel ❑Other ................•.....-- •--...-----....._ i Number of living units Number of bedrooms _.. ___Garbage Grinder _____..::... Lot Size ....................... ............... Water Supply: Public System and name ----------------- ._........._._.._..............-___-__._Private❑ ---------------_--•-------------- _.......- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loan'+❑. Clay Loam❑ Hardpan 0 Adobe❑ Fill Material ...........if yes,type ............... (Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. Faust be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size.... �1 _.... liquid Depth ............. r Mated No. Compartments -- ••---•-•-• r► " Capacity ---�- --- TYI� -------------------- � t Distance to nearest: Well �''� � ....Foun ation �� r... Prop. line ._..__ -s�...._. 0 If t ines ......I...-_.___•...... Length 4ff each Ilne....�..�---•...•-••• Total Length ---.7..LEACHING LINE No. o L ._.De th..filter,Material .-. ..8................................_ D Box :......._._. Type filter Material _ - p Distance.io-nearest:Well .:_-, ?..... foundation ------------------------ Property Line ......................... r SEEPAGE PIT Depth ..1+ ------•_--• Diameter fit Number .........:. :.......__.... Rock Filled Yes No Water Table Depth ____� - � ,,// g �....................................Rock Size �.ZZrJ�:_��......... Distance to nearest: Well ---- 6 - ---.Foundation _��9----------- Prop. line ....: ...._.... REPAIR/ADDITION(Prev. Sanitation permit�# _...._._-__:_____.__•-----.......•---__.---- Date _________________---•-----.----•) Septic Tank (Specify Requirements) ......-'....... ---• - ---- ----------------------------------- ................ rte„ oe Disposal Field (Specify Requirements) ........ _ r" ----------------------------------------------------- •--•------------------------------------•••--•--•---- ......................... ----- ---•-----•----------I--------------- ------------------- -•-------- ........................... ...............__................................. 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 Heal&District, Home owner or.licen- sed agents signature certifies the following: r i "I certify that in the ormance of the work for which this permit is issued, 1 shall not employ any person in such manner i as to beco a sto arkmae s Compens ton taws of California." Signed ' ........ - ------ -- if other than owner) /® --------- By __----------------------------------- (if ---------------- ----------- -- / .........-_ Title .. . _:.._....-.._... f I E DE0ARTP6jiNT USE ONLY . APPLICATION ACCEPTED BY DATA,-.9:�: '� ~,: ....:. ------------•-•-- ------ BUILDINGPERMIT ISSUED ------- •-••----_---••--•• ---- .................. ........................................... -----_------------- ADDITIONAL •---_---------- --ADDITIONAL COMMENTS ....................................._............ ----_-_----------------------------------------------------------------------------------------------- ----------------------------- - -• -------------- ---------- :-- - -- ----------------- :..---------- " 4 -- �— I final Inspection b �/ - • • - - - ----...Date .. EH 13 2L , 1-68 lfev. 5M SAN JOAQUIN 1.C3 HEALTH DISTRICT 8/74 3M