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FOR OFFICE USE: APPLICATION FOR SANITATION P.ERMIT ' Permit No: .��:: ......................-............................. (Complete in'friplicate) .. ` Date'Issued .--.- - 7... This Permit Expires I Year From Date Issued # .:.Akpp:................. .... ................. f. Ort once No. 549 and existing Rules and Regulations: Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein 2f� his.application is made .in complian ith County described. T ` . Tt, T CENSUS TRACT DPS3 'x:`37 c ................ 108 ADQ i:55/LOCAT ._._.. `U_ .:.� ../-.(few .! ••-•./... ,1 •••- --••••---. ....... a .,... Owner's Name .----- . .. .� .....----..... City ��G'......................... Address ... ......�W. . ........ Contractor's Name ..License # c els � Phone`...•.... .... Installation will-serve: '...Residence. partment House Commercial{Trailer Court 0 � - ' Motel 0 Other ` Number of,living units:.....___./Number of bedrooms ' _Garbage Grinder ,.. Lot Size • G ofi '3,1'Ji�' ••�� _._ -....... .........................Private Water Supply: Public System cnd,name ......................................... , Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Q Sandy loam fl Clay Loam ❑ Adobe . ill Material ......... .-If yes,type ............... ..........•• Hardpan Q (Plot plan, showing size of lot, location of system 'in relation to wells, buildings; etc. must be placed on reverse side.) -,1 NEW INSTALLATION: INo septic tank or seepage pit permitted if ublic sewer'is available.withln 200 feet,} F Si .. .$y .. Liquid Depth ... ?�>.... M, PACKAGE`TREATMENT ' I I SEPTIC TANK t ....... Capacity Type Material2) ..... No. Compartments �••••••-- - Foundation Prop. Line .. .......... Distance to nearest: Well, : ••--•--- � yy -..,f Total Length , � - 4 LEACHING LINE o. of LinesA`... ct►°�in�. - --= Length of ea 11 F 'D' Bax .� �. Type Filter Mateiial .�'�a- -.Depth .Filter Material .../...�:.�.... ............. .... .._.. Foundation a -......... Property Line ..: .............. t h pistanc to nearest: Weil _..�.��._�....j.--- -- .... Rock Filled Yea.-El-:— C3 Diameter,_3.1? - Number � r SEEPAGE Depth. ........... Diameter •----�- _ ..--- Rock Size Water Table Depth ....�!�-Q-•-�• � -•- Distance to nearest: We l------ .... ..........Foundation . Q•�.-.,..__`Prop. Line REPAIR/ADDITION(Prev.;Sanitation'Permit .- ........ Date ................................ 1 Septic Tank (Specify Requirements)'......-:=•••--•---• Disposal Field (Specify Requirements) __.-•. -- ..... •- I _..___..___-____________________.___-____-._--____._..--___.... 7. .............. ................._-----------------__-._--------------------------5--___-_.__-_--.-____..----_--•__-.-_r..............-...-----------...__._...._.........._.__......................- ':-y�'.- -� (Drow.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 l County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Homo owner or licen- sed agents signature certifies the following: permit is issued, I shall not emparson in such manner certify that in the performance of the work for which this ploy-any p as to become subject to Workman's Compensation laws of California." Signed -----• ----------- -----1 ---- Owner �. -- .............. title _ ....... . By ------------------- } (I# er than owner) FOR DEPARTMENT USE ONLY . -- ----------.. DATE ..-._... ---... .7_�-------------••-- APPLICATION ACCEPTED BY ----...-- ' • -------- - .. - - -- ---•--.. ..'........ .......•---—........ BUILDING PERMIT ISSUED --------------•------------ ----- - DATE ............ ADDITIONAL COMMENTS ---------- -•---------•- . ---------• -------• -........... --------. --- ---------------------.._..........-——...........--•--- -------------•----- Final inspection by:--6-,..1__._.. Date .,� " 4 . EH 13 24 1-68 Rev. SAN :IOAQIJIN LOCAL HIrAITH f]ISTRICT 8/7h 3M 3