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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit lComplete In TApllcote) This Permit Expires 1 Year From Date Issued Date issued _1�. 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 __._... . .... ._._.U4ar_ .. .___.CENSUS TRACT . Name ............... C �c e .................................... ........../...........Phone ..--................ 1.............. Address .._._...._.. .. . � '"ti`'�• .................Ciryu4, Contractor's Name -------- ---------------------------------------License 0 ........................ Phone ... ---------------- Installation will serve: Residence©Apartment House q Commercial❑Trailer Court Q Motel E]Other..... ..................... Number of living units:-.--./-_.-- Number of bedrooms . .2—-Garbage Grinder ............ Lot Size ....... ----------------- Water Supply: Public System and name _..--------•--...-----•..................................------------......------------.............----------Private Er Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam {] Clay Loam ❑ Hardpan C7 Adobe Fill Material ............if yes,type............... ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.l NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) , PACKAGE TREATMENT ft] SEPTIC TANK% ,p Size_...42.0!Q....................... Liquid. Depth .-•-�-�-6----......_. . Capacity _,1.ad...._.. Type (/ :4Q.� . Material.. .�fcti� No. Compartments ..._..� ..-- Distance to nearest: Well --.-- s .............•_.-___-Foundation Prop. Line ..r;?�S.....c...... LEACHING LINE [,� No. of Lines ....____ ._...______ Length of eadt line. f'._ .�� Total Lenglh �__.. -s....... - D' Box ....../---- Type Filter Material�r'c� �! _C'a epth Filter Material ...._.../I.................I r f - •--/......_. Distance to nearest: Well ......... Foundation _._. a...-...... Property Line _.... ............ SEEPAGE PIT N) Depth A-r-_r------- Diameter .. s.�'.---- Number _._.....��`'...--••-_.... Rock Filled Yes-M No Q Water Table Depth ----. -Oa:--_--------------------------Rock Size ................... Distance to nearest: Well /00--1...........................Foundation ............ Prop. Line ............ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. SepticTank (Specify Requirements) .................. -----------.............................................. ................................................... Disposal Field (Specify Requirements) --------------_-------------------------------• --------••-•------- -----------..-......-...----------------------------- ....... -------- ---- - ----------•-------- _.-•--••-•---••---•--------•----------------------------------------------I.---.....------... (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. Hort* 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 manner as to beco e u to orkm Co a sation laws of California." Signed'- _.. _. ----- - ----- .................................... Owner By ---------------------------•------------------- ----• •------------- Title (if other than owner) FOR 9EPARYMENT USE ONLY f APPLICATION ACCEPTED BY .............. BUILDING PERMIT ISSUED . . c�d ---•----•------ .. DATE........_ .. ....- - ...................... ------- -- ----..--- ---------.-------------- ....... --- ---DATE ___._...--- ---- •-•- ------................... ADDITIONAL COMMENTS ------------------- -------------------------- -------------- - ----------------- •----------_-------- -•--_._:..__..I——---•-------------- •-----.••--------------------------------_.-.----------------------. ..---------- - ff Final Inspection by: -•--- --------• .-------------------'................................�---•-•• ....-----..._....---•----------Date .. ..r� ,J fp._ 13 2!t Z-68 Rev. SAN JOAOUIN LOCAL HEALTH DISTRICT 8/7Ii 3M