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FQR OFFICE USE: � APPLICATION FOR .SANITATION PERMIT .------•........................... /.,►.crc :..: ate Per o. Pe it N : •n W (Complete fit Triplicate) ..:...: .................... Date issued .. ................ .................. This Permit Expires t Yew From Date Issued fi =Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein 'E This application is made In compliance with County Ordinance .No. 549 and existing Rules and Regulationst ` JOB ADDRESS/LOCATION ....... ..-�,. 2 CENSUS TRACT } Owner's Name' '_ l/1,1 . .... ....... .- '-•• Y Phone .......................... ....... ' ............ . Address ......:�'�.�_�:�.4�'.---.....G..�._..__� ------.... .......... Ci�. .. .. ...... _... icense # c20�l7- .. Phone- - . Contractor's'Nome r r Installation will serve: Residence Apartment House C3 Commercial oTrailer Court 0 ' Motel C)Other --- ............................. •-----•-• Number of living units------ Number of bedrooms .__�...Garbage Grinder- Lot Size .._ ` - --�1� ••- Water Supply: Public System and nam ` -........... ...............................1 ePri ate[3 t Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat[I Sandy Loom ❑, Cay Loam❑ i s + Hardpan Adobe Or Fill Material If yes type (Plot plan, showing./size of lot, location of system in relation,to wells, buildings, etc. must be placed on reverse side.) s ' NEW INSTALLATION: {No septic tank or seepage pjt permitted if -ublic.sewer,is available within 200 feet,) j PACKAGE TREATMENT f ] SEPTIC TANK f �. 4Si *= - ------. ................ Liquid Depth ....-___••--••-----•,---•• ' " ' " ' ...................... 6 Capacity ........ ...... .... Type .. Material No. Compartments i Distance- to nearest: Well .......= -F u :. . Prop. g ndation .. LEACHING LINE No,of-Lines =- .... .- Length of each i ne.._.: � T---........ Total'Length ......--- :� i '.D ox - —_.. Type Filter Material : Depth filter Material .....�-��•-•-...... ..••---...... 4 ,. ! f. / Distance to nearest: Well . ..... Foundation .0/�............... Property Line .. ._..........._... SEEPAGE PIT Depth .. �:... Diameter . ........ Number -----elI.::................. Rock Failed».. Yes '° No . . r „� . Water Table Depth .................... -- _.....: .. Rock Size 'e 4 line Foundation - . 4 Plop. e :• Distance-to-nearest:-WeN— G� �'=` - {- •_.. i REPAIR/ADDITION(Prov. Sanitation Permit'#` .....-- ---------- � Date --------- ------------------- ) ' ' , Septic Tank (Specify Requirements) r = -------- ..... .'!_ .rex• Disposal Field -(Specify Requirements) .--.1� . . ---------- ---- - (Draw 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. Home owner or Iicen- sed agents signature certifies tele folio ng:• r "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 become subject to Workman's Compensation laws of California." ' Owner F Signed ..---------- - - -------------------- --- --•-------"..--- ` i` ................ Title ----------------------- . - [ f other than owner I i OR PAIRTMENT DISE ONLY E APPLICATION ACCEPTED BY .._� ,_. .. _- - ------ _...._,.,..._. TE 91J IJING PERMIT 1S ED ...7. ..:. ............. .....DATE _...--------•--- ADDITIONALCOM --------------- -------------------------_.....------.........._..--.-•---- ------••--•---•-•---..... j •----•---. ------ .................... • • ------ ........................................••.............. ........ ' Final Inspectio by ----------------Date .......... ....... i EV 13 24 1-68 QUIN LOCAL HEALTH DISTRICT 8/74 3M