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rFOR OFFICE7USE: APPLICATION FOIE SANITATION PERMIT ................. � i (Complete in Triplicate) Permit No. ... . ... ... ................... _.... .�:. �' .....................................:.......... ..... This Permit Expires #I Year 666 Date Issued pate 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 mode in compliance with County. Ordinance No. 549 and existing Rules and Y .. . .... Regulations- JOB i ons: .OB Ab]Rf55/LOAT#ON _ / C.......... .......r..........................CENSUS TRAC ..... ... phone ...... Owner's Name / . . ... ............ Address ..City � Contractor's Name .-- .; hone _ . ............... : ... cense #` P .................... Installation Will serve:> 4Resfdencel[I Apartment House f3 Commercial[]Trailer Court Motel ❑Other ..../ a .//�_C. f ( '0,15, - - Number of diving units_____________ Number of bedrooms { -' Garbage Grinder Lot Size Water Supply: Public System and name ....._ ---------- t ' Private -....._........... _........ .-•---•..... .................... Character of sail to a depth of 3 feet: Sand)< Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ a r A. Hardpan (] Adobe 0 Fill Material ............ If yes,.type . ........... ............ +�. - (Plot plan, showing-size-of lot, location of system in relation to wells,-buildings, etc: must Abe placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer_is av 9•loble within 200 feet" 4 PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size...... ..... Liquid Depth ........................�- m Capacity AZC3:2�_._ Type F . •------- Material---_---------•-•---. No. Compartments ...2..........:.5' Distance to nearest: Well ----------e5– .Ay�..---.:--..Foundation ....... Prop. Line ........... ._ LEACHING LINE [ ] No. of Lines ......./_------------ Length of each line._......174. OQ .!��..-'Totah Length �6,...� -�—.. ............: 'D' Bax ...__.____-- Type Filter Material .............. Depth' Filter Material .............. Distance to nearest: Well :.....foundation ` _ -•--•-•--------------�='Property Line ._................... .. . SEEPAGEPIT �.. ., [ ) Depth __-.- Dlarnete Number ..___..._.._.,.:!/..._.._.. Rock Filled Yes No Water Table Depth --- -----------------©. ----•- ---------.-Rock Size ..X .. . Distance to nearest. Well ------- _....___•...................Foundation :.__......._......__ Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# ---_..__------------- ----------------- Date Septic Tank (Specify Requirements) -•--•-----------------------•-•---- ----.----------- ................. Disposal Field ISpecify Requirements) ---•--------------------•- ._..-------•--------- ---------•----•--------- .. -------------------•----- (Draw existing and required aiddition on reverse side) .............. .. . I hereby certify that I have prepared this application and that_ithe_work.,will. be-clone In accordance with San Joaquin Countylprdincinces, Stolle Laws, and Rules anti Regulations of the San Joaquin local Health:District. Home owner or licen- sed agents signature-certifies the following: "I certify that In the performcince.,of the work for which this permit is issued, 1 shalt not employ any person in such manner as to becomesu ' ct to Workma '�Compensation laws of California." Signed ------- --- -------••------------------------- Owner By --- ---------------------------•------•----•---------------- -------------1 Title (if other than owner) ------------- rO DEPARTME T USE ONLY APPLICATION ACCEPTED BY ..-- - - - - -. -- --..--_- .. DATE ..Z .3:... BUILDING PERMIT ISSUED ---------- . ._. DATE .............•- --•--....------------- ADDITIONAL COMMENTS --------------••----..------•------------. } I --------------------------- .____.._._.................................. ................ . . ------------------------ -------_---- . ..-. ----- - .........__.___•__.._._. -..----.._......._..-.-.....__..__......___.__._..................... i ------------------------------_------. . . . -------- ............... ...................................................................................... final Inspection by: --------------- - Date -? -_-72.1 7. ... ( ... ........• ... EH 13 2h 1--68 li?ev. 5�t SAN JOAQUIN OCAL HEALTH DISTRICT 8/7h 3M