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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 Permit No. .:7G-�•• - (Complete in Triplicate) Date Issued . ...... _ This Permit Expires 1 Year From Date Issued to the San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby mode described. This application it mad Son compliance with County Ordinance No. 549 and existing Rules and Regulations: r /L .. JOB ADDRESS TION > >� .�/�7U . . aG ENS ACT.._...................... Phone i Owner's Name .. . .. . _... al. .�.... �/ - -'.......... City . .._ _.... .. Address .........:.... ..... .. _ a_,_ _ - .:..........License # .�f..Z7,3..�.'.Y. Phone ................... .Contractor's Name . -- Installation will serve: Residence Apartment House : Commercial ❑Trailer Court [] Motel ❑Other . .............. ..... Number of living units:_/------- Number of bedrooms fir'---_.Garboge Grinder ..._....... Lot Size .................. .. ... . . .... .....................Private Water Supply: Public System and name .................................... ...... ..... .. ...................... .....__......_...... ........peat Peat Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ ❑ 'Hardpan Adobe Fill Material ..:......... if yes,type . ......._................ _ ❑ter ti must be placed on reverse side.) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. NEW INSTALLATION; (No septic tank or-seeps pit permitted if Public sewer is available within 200 feet,) ``jj / / ,/ / $'..�........ Li uid Depth ....�......_........,,,• PACKAGE TREATMENT_ ( l SEPTIC TANK Size...x./,.7...it..f�.... �..... q 4 -- No. Compartments .....................t}1 sh< f. Material n i 9 'CoPacity ��-6..0.. °... Type , '. . Foundation ...L.tl.-:-- --• Prop. Line ...-.`.f.^J-----•�y 0 Distonce'•to nearest: Well - -- - EAC—' LINE [ }� No. of Lines �•-- Length of each line....`..... �.--- ---- Total Length"_./ zo................. - •ty - ..MW .� l Type Filter Material ....-5._R---.. -Depth Filter Material .. J � _ 'D' Box ...., ... . ., � _.... Distance to nearest: Well ..._�50.�.-....' Foundation ... . Property line Depth J -�... Diameter _-3 3- ." Number ........ 3............... Rock Filled Yes No ,. . I SEEPAGE PIT [ Water Table Depth ."....L -...............Rock Size .�'....X ' r i ........Foundation .�_0..�........ Prop. lino ...`............ . Distance to nearest: Well .....t.b"b_:............... . Date --------------------' -} REPAIR/ADDITION(Prev. SanitationPermit .......................... Septic tank.lSpecify Requirements __ .__...... .................................. (of Requirements) ..........-... .-_------_---------- ............................................._............_......_........_........__....... Disposal Field (Specify _................_...._.................................. _._......._....._...., .._. ... ...... ........... .... -- .... ......................._............._..:.. .._.................... :-..." ..'"" (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 cc me with San Joaquin Rules and Regulations of the Son Joaquin Local Health District. He County Ordinances, State laws, andrve owner or lino- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, { shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Owner Signed .:.. . - ....... ._.........._ ........... _ ... (If other than owner) FOR DEPARTMENT USE ONLY m, _ .. . . DATE /0 I. ................ .. DATE . APPLICATION ACCEPTED BY ... - ' " BUILDING PERMIT ISSUED .... . . . ... ... . • ADDITIONAL COMMENTS ................... _.._- .. ..................................... ' ............... ..........-.--.,. .. --... _ ............. ...-- . ..._......-... ....,- --.....----.-._...._ _ Date Y /..7. .. ............. : Final Inspection by: ....... -----. ........---......_..................... .. . .... I SAN JOAOUIN.LOCAL,HEALTH DISTRICT.. 7'/723 ,.4 . _ .. , obi .._ ..