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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT...............I.---_....: permit No. .................... (Complete In Triplicate) . ...........................---.....:....._..--•--••._..... 7 ..............ry............................ . This Permit Expires I Year From Date Issued Doti issued ................ Application is hereby made to the P Son Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compliance with my Ordinance N0. 549 and existing Rules and Regulations- .................................CENSUS TRACT ......................... . .......... ...... JOB ADDRESS/LOCAT Owner's Name ...... ....Phone ........... ..................... .......... City Address ...... 4.5.4n,.......3r .ttg CI ......0��..................... ... ................... C- J Phone ............. ........ ...... Contractor's Name # Installation will serve, Resid nce(3 Apartment House{] Commercial OTraller Court 0 Motel 0 other .......#0 Number of living units ...... Number of bedrooms ..........-Garboge Grinder ......... Lot Size ........................ ------- 7J4�; Water Supply: Public System and name ............ ----------- ............... ...................................... ... ......,...Priya te Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay [3 Pedt-ri, Sandy Loam Clay Loam 0 Hardpan 0 Adobe 0 Fill M6terlol ............ If yes,type ..... ......... ............. Mot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse st e. NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) � I ' 1 4 1Z PACKAGE TREATMENT f ] SEPTIC TANi,17 Sllze.0�1�:Z.................................. Liquid Depth ..t...�....... Copocity'2t;)�0-.-.--- Type FAX--e�J Material No. Compartments ....... ............ 4� to nearest: Well P-k:1...........Foundation..--/J�/..........Prop. Line Distance ......... . ....... LEACHING LINE No. of Lines .-_.:Z:._•_-__-_..... Length of each line.... .......... ......... Total Length V Box ------ Type Filter Material ........Depth Filter Material ... .............. Distance to nearest: Well ...... Foundation .... Property Line .... ............ SEEPAGE PIT (1/1 Depth ......... Diameter --qi------- Number --.3.-------. ....._ Rock Filled Yes, [I No 0. Water Table Depth -------------- ....................Rock Size ...... ....... Distance to nearest: Well -JX-12.4-t------------- ...Foundation ...... Prop. Line ...... i----------- REPAIR/ADDITION(Prev. Sanitation Permit# ........... Date ............. .............. Septic Tank (SpeciRequirements) ------------------------ ........ ....... ..........4.............. .......... ------------ ...........I................ Disposal Field (Specify Requirements) -------- ------ ------------- --------------------- ...... ........... ........................... .............. - ------------------------------------------------------------------------- ............................ ............. ... .. . ------------------------------ -------------------------------------------------------------- -- ..................-......... ............. ............ ............... ....... (Draw existing and required addition on reverse side) I hereby certify that I have preP:aied this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin local Health:District. lJorne owner.or.11cen. 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 mariner as to become subject to Workman's Compensation laws of California." Signed ------------------------------------------ ---- F7------ Owner FQR)D - ------ Title - ............... .......By ----------------- ----o---------- ilf other than owner) EPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- --------------------------------------------.................. .DATE, 9:73:zt BUILDINGPERMIT ISSUED ------------------------------- ............I............... ------------------------- ......DATE . .. .......................----..._..--- ADDITIONAL ...... ......ADDITIONAL COMMENTS ---•--,...!._._.......-•----------•----•--••----.•----- ------ ----------------------- ............................ ........................ .................... --•-------------------------------------...i----- ------------------------ ------------------------------------------- --------------------•...................1--l-........................ ............... ----------- -------------------- --------------------4-1-,�--- ------ -- - -------------------------------------------------------------- ---------- ------------- ......................-Da: - " ........... Final Inspection by. ........ ............ ...... ............1----------------------------------------- ---------- --------------------------- --------------------- -------------------- ........... --- ---- ------------------------ -------- SA EH 13 2L 1-68 Rev. 5M N JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M