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F aR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No. -- (Complete in Triplicate) ............. . - -.---.. . - This Permit Expires 1 Year From Date Issued Date 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 made in compliance withCounty Ordinance No. 549 and existingRules and gtyons. JOB ADDRESS/LOCATI N e . _, >yz-� � `� L'ENSUS TRACT ..... Owner's Nam-6--A._t:2�,�� . . l - --- t' Phone .. Address 5 77 Cit r y - - Contractor's Name 7 .. . . t -- Phone _... `t. License # ! 9 Installation will serve: Residence partment blouse❑ Commercial ❑Trailer Court :❑ Motel ❑ Other ..._..... Number of living units: ).. Number of bedrooms —3--Garbage Grinder Lot Size Water Supply: Public System and name - - --------- ...........Private [ � Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan �K 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.l NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK 1� ( � E� 44 Size.---. -.�_- -�--.. . --X- � Liquid Depth _..........---- --- Capacity 01" Type t�` -� Material- 'C --- {- _ ..__... • No. Compartments ,.?�...--._...- Distance to nearest: Well ..._ -----1e jJ(400 7-----.----Foundation 10 /_ ....... Prop. Line ...- ---------------- r LEACHING LINE No. of Lines r 'r L Length of each line f Total Length _� �- ------ - ---- ---- 'D' Box J...... Type Filter Material ... .....Depth Filter Material - - �._....-- Distance to nearest. Well __ ..._P._... ----- Foundation !_0--.... __--- Property Line .s~--� . . - ..- .- ., SEEPAGE PIT [ Depth .....o .- .- Diameter .___ ..3__- Number _ t ..__ ...... .. . Rock Filled Yes Er No ❑ Water Table Depth ------ --- - - '- ----.-.--Rock Size Distance to nearest: Well _.. . _-- i'}...�.--- --Foundation �(.-C?._`.._. Prop. Line ------ -.f--.-.- REPAIR/ADDITJON(Prev. Sanitation Permit# ........ ...... . -------------- -- Date __----__----------- Septic Tank (Specify Requirements) ------- r Disposal Field {Specify Requirements) —-- ------------ ...... ........ ------ . .. -- .._ ..... ....... (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 E 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .. Owner BY 0- -0 itle . (If other than owner) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ... — - - ... BATE /- 7 ........... ... NG PERMIT ISSUED DATE ADDITIONAL COMMENTS ..... ----------------- ----------------------- -.. ........ - -------- --- . .. ... _ . ------------- Final Inspection by: .... Date 73 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M i J