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FOR OFFICE USE: I APPLICATION FOR SANITATION PER IT (Complete in Triplicate) 4 This Permit ExpireDate Issued s 1 Year From Date Issued 5�.f�• 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. . .............. .......CENSUS TRACT Owner's Name ... _ :�V _ . _�• - ------- �K-��Q/_.,•..............:... .......... . ..Phone _ -- - / City -Address ...... ••---- !o._ Contractor's NameLicense # .. 9v �� . Phoneelc. Installation will.serve: Residence fiTApartment House Commercial oTraller Court C] }! Motet E]Other................:..........:.............:.. Number of living units;..... Number r i of bedrooms S2.....Garbage Grinder ............ Lot Size ......_ ........ l Water Supply. Public System ant! name PP Y ............................................ ................................. ................Private Character of soil to a depth of 3 feet Sand O Silt O Clay ❑ Peat.O Sandy Loam a Clay Loam Hardpan [ -r Adobe)Z Fill Material ............If yes,type ............... ............ i (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,l ' PACKAGE TREATMENT f ] SEPTICTANK f } Size---------------------------- ---••--•--•--- --- Liquid Depth .......................... Capacity --- ----------•---- Tyles ----... Material-----.................. No. Compartments ...................- Distance to nearest. Well ....___.....—.......................Foundation ...................... Prop. Line ...................._. Q LEACHING LINE [ J No. of Lines ................... ...... Length of etch line............................ Total Length ............................ %Y `b' Box Type Filter Material -----.Depth .Filter Material 6. Distance to nearest: Well ........................ Foundation ------------------------ Property Line ..............:............ i SEEPAGE PIT ( J Depth ........... Diameter ............... Number ---- .........._. .............. Rack Filled Yes ❑ No O.Q i Water Table Depth -------------...................................Rock Size ------.... i Distance to nearest: Well .........Foundation ....... Prop. Line ...........:.......... '1 REPAIR/ADDITION(Prev. Sanitation. Permit# ....... .......•-:----------------_------- Date ....... --••---... ---__-� Septic Tank (Specify Requirements).. /0, ,....`-.....4`Q .....:. C?Ctrlcl.. ........................ 17 ; 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 San Joaquin County Ordinances, State Laws, and.Rules and Regulations of the San Joaquin Local Health,District. Home 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 sh a Il not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------4wr .-- --- ....................... Owner i By Title (if other than �..:......... _....... 1 FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY __ - ...... .. ... .. / DATE --,.. BUILDING PERMIT ISSUED ------------ --!.. = DATE ADDITIONAL COMMENTS ..---------------- u ----._.._-__...._.._._ i ...••------•----•-•--••-•......................•.......---•------------------------- .................-- --- •----------------- 1 } I t� final inspection by- ------------- __.._.,..,._ ... �- -------•------- ! EH 13 2h 1-68 Rev. 5�q SAN .IOA IN LOCAL HEALTH DISTRICT $/7h 3M i