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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................----........ _ y ........................... (Complete In Triplicate) Permit No. .��.....�G. .. ..........I....................• ................. Date lssued This Permit Expires 1 Year From Date issued 1/1-12..7j p�7— !Application ®2- is hereby made to the San Joaquin Local Health District for a permit to con&61 and €nsta(I the work herein described. This application is,made in compliance with County Ordinance No. 549 and existing Rulqs and Regulotl s• - 5 f/ TRACT ' 1B ADDRESS%LOCATION .----- _t �t ............... ...... -�•��CENSUS T .......................... Owner's Name ------Zai. ----T�0_A.• --G,tYr..:.��p__�... .P_G�_. ..._ ...... ......... .. .&.--,..Phone - Address .............22z.C,--.-(�C� LZ/je �K v' , _.... •..................................._.city ........� ..._..._r..._.....••---- .................... .........-•-...-- Contractor's Name l .....License #,0Y7e. 2/ Phone Installation will serve: Residences❑Apartment House 0 Commercial r]Traller Court ] Motel ❑Other------S!! .4t- .................... 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❑ Cloy eat❑ Sandy Loam o Clay Loam o ll, r Hardpan❑ Adobe❑ 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.) NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize.----- y} .....-•------------------•_....... ....... p... Liquid Depth .. Capacity 00_40- Type /_0012. .� -• .411-Material No. Compartments ... ........'.� Distance to nearest: Well _..-` .....-f...............foundation .-.Lf1.�. f'.._ Prop. Line .l d.... LEACHING LINE [ J No. of Lines __--__ r --•............. Length c�f each line... Total Length -:5-0-0 ........ /! /r 'p' Box _.. --_--__- Type Filter Materialyrr.OG�_. Depth Filter Material ...1 ............---------;----------- Distance to nearest: Well ...� -?`._._._ Foundation ___�. a_F...... Property Line .1.0.............. SEEPAGE PIT • ( } Depth ... -2Diameter __33 Number ........ ......... hack Filled Yes 25--No 0 Water Table Depth _......- ... � .............................Rock Size ---- ........................ Distance to nearest: Well ---_..1 `..................foundation -_ Prop. Line .... ..P......... REPAIR/ADDITION(Prev. Sanitation Permit gig ----------- ----------------------_ ------ Date ...:--....... .................... Septic Tank (Specify Requirements) .............................................................-...................---........................... ,..._.. Disposal Field (Specify Requirements) ... ------------- ---------------- ----------- -------------------------------- ----_-------------- ..._.........................._............................................I.................... . (Draw existing and required addition on reverse sidel 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:District. Hattie 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 :Wanner as to becomeub e.c o Workman's Compen ion laws of California." Signed •---- / Owner By -------------------------••----- ------- ---• Title (If athe an owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ... ---. - - . - . <--- ------------•• DATE .. . �.. BUILDING PERMIT ISSUED ....-----..: 7. . - - DATE,... ADDiTIONAI COMMENTS _.__.. �? --_ ---- --_.. . . . -_...-----•----- ----------•---- •--- ----------------- �- -------=------------ -----........ - Finol Inspection by: _._ Date ..... - _..'J._.._.......... - •--- •-•----------------------- .... EH 13 21a 1-68 Rev. 5 SAN JOAOU LOCAL HEALTH DISTRICT 8/7h 3M r