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FOR OFFICE USE: i APPLICATION.......................... POR -SANITATIOt�IT (Complete In Tripllca ... ............... This Permit Expires 1 Year From Dot*1 ed Date Issued .y-4�.�72 Application is hereby -node 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 ADDRESSAOCATi �/.-L�_L. .,... .... ...... ..... CENSUS TRACT ................. Owner's Nome .. !�'�'1 t7 ?,........ .. . .......-1...........STy s.17 ...... -Phone7�'Y' Address .......b..� ?.-. .... . . !.. ....... .. City - - Contractor's Name ............. ........ .. .. .. License #��Scf: j.... Phone .. fa...........�. ... Installation will serve: ResidenceApartment House'❑ Comtnerci@❑Trailer Court fl / Motel C]Other............................................ Number of living unks:.....1...... Number of bedrooms ._7�'.....Garbage Grinder ............ Lot Size ..__..`.".--"`:.T.......... Water Supply: PublicSystem and name ..........................................:............_.............._.----------*. ....................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam Hardpan E] Adobe ❑ Fill Material ............If yes.type............................ (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,) PACKAGE TREATMENT ( ] SEPTIC TANK I J Size---------------------------------------------... Liquid Depth ..... ..................... f,Cdpacity .................... Type .................... Material...................... No. Compartments ........_............ Distance to nearest: Well ..........................._.......Foundation ...................... Prop. line..........._......... LEACHING LINE No. of Lines ........................ Length of each line............................ Total Length _........................... 'D' Box ............ Type Filter Material ....................Depth Filter Material ..._........._...._........................ ') Distance to nearest- Well ........................ Foundation ........................ Property Line .................. SEEPAGE PIT Depth .................... Diameter ................ Number ...........7............. Rads Ftlled Yes ❑ No Q Water Table Depth ............. ......_......-......_..........Rock Size .............................. Distance to nearest: Well .......................................Foundation .................... Prop. Line ........._........... REPAIR/ADDITION(Prev. Sanitation Permit# ........................................... Date .................................. Septic Tank (Specify Requirements) ............................. -----.... .. .f... .. . - Z • .._.Disposal Field (Specify Requirements) ..... n . ' - . ................. - . . .......................... . ..................................... ........................ .... ... ......................................... ......... .................................... (Draw existing and required addition on reverse side) 1 hereby certify that 1 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, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed . _....._ - - O By . er - Jt1e _.... ... .- ------------- ------------ ow r 52R DEP ME US NLY APPLICATION ACCEPTED BY. -.-..... ... .................. _ ....... .. ....... DATE ................ r BUILDINGPERMIT ISSUED ........................................................._........------ ............................DATE . . ---.--..................._............ ADDITIONAL COMMENTS. ........ .......................................-.................... .......................... ....... ....... ... ................._...- .......... ......................... ........................ ............. ...:.... ...__..... ...... ..... ::._.............- .- - .. ...... .... .... ........... mal Inspection by, ..................... ...... ..... ..Date _ /:.�. . SAN JOAQUI LOCAL HEALTH DISTRICT E.H. t3 241:68 Rev. SM A17/72 3 x