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tOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- ....................... _ ..7�-y3� lCompfefs in Triplicate) Permit No. Date Issued ....... 7 ...............................I......................... This Permit Expires f Year from Daft 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 Or finance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N �f 4-C&..CENSUS TRACT - +e� `...E .... ....... .................... -- Owner's Name ...... ...... :... .. ........................... ..... Phone i . ........... .... ... . Address . t...: ... .. .......t'• c... ........._F......,-...City .�-4. .............. Contractor's Name ---- - License ...:........:........... Phone � � ��_. Installation will serve: Residence Apartment Houseo Commercial❑Tra€ler Court 0 Motel ❑Other-............. _................... _-------- Number of living units:.... Number of bedrooms � _.-...Garbage Grinder ............ lot Size _61-1............... .. Water Supply: Public System and name .................• .........................................................................................Private Character of soil to a depth of 3 feet: Sand t] Silt❑ Clay ❑ Peat❑ Sandy Loam o Clay Loam a Hardpan Adobe 0 Fill Materlal ............ If yes,type............... .......... 0 . (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 ize._�./>C i ... _..-----•---•.__..... Liquid Depth .----7�11_..-- r2to0 ' Y Capacity ----••--- TYPe �------------ Material------- .... No. Compartments ..:.:Z.............. Distance to nearest: Well ....................Foundation ....1_0. �.._•-••-- Prop. Line .... .... LEACHING LINE No. of Lines ---------- Length f each line.._,®Q. .......... Total Length `......... .._ t/ 'D' Box ... ....--- Type Fitter Materia .. ' �`eLC '_Depth Filter Material ._. .9... ................................. s Distance #o nearest: Well /..�r.............. Fou dation _1=0.'.'__...... Property Line �................. SEEPAGE PIT ( l Depth .................... Diameter ................ Numbers--------------------..------ Rock Filled Yes ❑ No Water Table Depth .......••.......................................Rock Size ................................_ Distance to nearest: Well .____•..................................Foundation -._.--..--- ........ Prop. Line ----------._____---, REPAIR/ADDITION(Prev. Sanitation Permit+# ------------------------------- ...... Date ------..__....................... Septic Tank (Specify Requirements) ° ---- ••---•----•----•............. Disposal Field (Specify Requirements) -----•--• ....... --------------......... .................... ...................•-..........._................ ------------------------------------------ ---------------------------------............................ ---- -••••••-•••-----......-•-•-•---•-•---------•--•-•--• -----•--- (Drow existing and required addition on reverse side) I hereby certify that 1 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:District. Homs owner or licew sed agents signature certifies the following: "I certify that in the peKormance of the work for which this permit is issued, 1 shall not employ any person In such manner as to became su .ect t orkma�n''s Compe ation laws f California." Signed ----r 7 I By ------------------------------------------------------------- __. . Title l�.iCJ ^� _ ......... ----------------------------- l (if other than owner} _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .�f%.-- - --.-- ATE UILDING PERMIT ISSUED •-- - - __DD . ATE ........................... ....... ......_ _.._ ADDITIONAL COMMENTS ----------- --_---------------- -- ...........---...........................•.......................... ----- ... Final Inspection by: ....�� -_ . _- --- - ------------ ---...•_._.... Date EH 13 2b 1-68 idev. ... SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7$ 3M I