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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT (Complete In Triplicate) Permit No. ...... ........ ...................••- --..--- --- _..... This Penit Expires I Year From Date Issued Date issued ...7 rr Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein describi� This appwl* do is, cle in compliance with County Ordinance No. 549 and. xistingnRules and Regulations: 1013 A`D[SRCSS O TION / CA ION CG ..... -. �....... .. ......... ....-... ............CEN TRACT' .......................... Owner's Name 1- ....--••.........................vf;....................................Phone ................................. Address ............ ...... .g. _.. .t. CL.�.n� .................I City _-..................._......................... Contractor's Name _. . .. .-- �. '�?- � .._..... ...................License � .�:..../.�.�.?. Phone ._1j_�.(Q_5.....�./__ Installation will serve: Residence W4'par rnent House t] Commercial ElTrailer Court C Mofiei ❑Other----...._••---.......................................... Number of living units:.....)----- Number of bedrooms,3.......Garbage Grinder. Lot Size ../�GLL!- S!�- --•__. Water Supply: Public System and name ............. ........_...._.._.....--._........-__................................................... ____.__...___.. ...Private Character of soil to a depth of 3 feet: Sand 1 Silt 0 Clayp Peat Q Sandy Loam ❑ Clay Loam Hardpan[] Adobe g3,1111 Material .,&O.'R If yes,type ............... ............ (Plot 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,) PACKAGE TREATMENT [ ] SEPTIC TANK.r 'ze__.ej,Y, � .-- -�... Liquid Depth .... ,f�?-.r....... CapacityType PQM-••_-•..... Materia)- ------ o. Compartments _....._.... Distance to nearest: Well .... !___,-...........---...Foundation`_/d_... ---------- Prop. Line ..CL-_._.__._. LEACHING LINE No, of Lines .......Z ............ Length of each line- Total Length ...... 'D' Box � -�-. Type Filter Material ' ..Depth .Filter Material . Distant to nearest: Well ............... Foundation ...f�0........--.... Property Line _.;CK............. SEEPAGE PIT Depth .... S.••�_-_-• Diameter -2.2..... Number --------- ........ Rock Filled Yes_W No Water Table Depth ........l., ...�----•-- -----•.............Rock Size -- ...j�.. Distance to nearest: Well .......1A ..........................Foundation d-'�----- Prop. Line ..5 ................ REPAIR/ADDITION lPrev. Sanitation Permit# -_-•-___ ----------------------------------- Date ................................ SepticTank (Specify,-Requirementsi ..---•----••----------------•.................••------•••..............---•----------•-----.....--•-•------.•-•,..••-•••..,_-•--•--•-••--•-• Disposal Field (Specify Requirements] ____------------------------------------------------------------------------- .....-----•-- ------•_...... -- --------------•---- ------- ............-............................................................................................ (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 Son Joaquin County Ordinances, State Laws, and Rules: and Regulations of the Son Joaquin Local Health:District. Hance owner or llcen. sed agents signature certifies the following: "I certify that in-the-performance of the work for which this permit Is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed -------------- • r •• Owner By ------------ 0. 1 ��-� Title . If other than owner] Fn R EPARTMENT USE ONLY APPLICATION ACCEPTED BY _.-_---- -- - - / J....::....:.:...:.... ---- --•- BUILDING PERMIT "ISSUED ---- ............................... ............ DATE . _.. . . .��----------- ADDITIONAL COMMENTS ----------•............... --------------------••-•----- - .------------••--------------•- ---------•-•------------••------•- ---••-------........._ .-..__-.-------.----/ finaf Inspection by: _....... Date ----•---....---- EH z3 2!t 1-68 SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M C