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. ------- APPUCA'i iON FOR SANITATION PEP'`°T (Complete in Triplicate) Permit No. ..._ .......... ..... ---•--------- ------- This Permit Expires 1 Year From Dote 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 with County Ordinance No. 549and /existing Rules and Regulations: JOB ADDRESS/LOCATION h .....`. ................CENSUS TRACT .................... Owner's Name -, - .....Phone -. - Address ---• ............ City ...... = Contractor's Name -- _-. ----- d -------- _•- ..........License # ..�l f Phone _��f" .i Installation will serve: Residence ❑ Apartment House C] Commercial []Trailer Court ❑ Motel ❑Other ----- Number ---Number of living units: .. ..--- Number of bedrooms _:?-_.Garbage Grinder.��_ Lot SizeQG`' -- ........ Water Supply: Public System and name ...... ------------------- -------•-------------•...........Private Q� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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 i`available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK Size----- /J.?.............. Liquid Depth ._�1................ Capacity ./ '0 4.). -- - TYPe ,4 '. C.� n _sL .:r .__ Material(�_il�„s <- No. Compartments ......................� Distance to nearest: Well ------.,lJ-u--'... ...........---Foundation ._ _ Prop. Line -------------s LEACHING LINE [� No. of Lines - ---------- .-_. Length of each line---/p--V...t........... Total Length / � �...............,p 'D' Box .11f.''_.. Type Filter Material ._} 4! �1.- .11 _Depth Filter Material . . f.... —� _ I Distance to nearest: Well _.. �.._ __._.._ Foundation V-----.__.._----- . Property Line ............... SEEPAGE PIT Depth .-. $-.------- Diameter ..3-4------- Number ._... ................ Rock Filled Yes 3----Ko C]�Z Water Table Depth I/�. / Rock Size _l%Z '. ------------ Distance to nearest: Well --------- ......................Foundation ........ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------.__..----__.___._. Septic Tank (Specify Requirements) ----------- ----------- ------ .._...... Disposal Field (Specify Requirements) _. . ` / _ - r -- --•- •----•--- ----- _------------------------ ---- -ate .. . - -----•-----------•-------------------- (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 County Ordinances, State Laws, and Rules and Regulations of the Son 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 ..._ . ................. Owne ---- ---- ------------------ ---- -- By - - -- _ ........... ---------- ------------ - Title --- er t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _... ...........----.....---•-• ................ DATE .. -�7- - 7........................ _BUILDING PERMIT ISSUED --- ------ -----•-------------•---- _-------__.......DATE . . . --------......----.............. ADDITIONAL COMMENTS --•---••-- ...... - --•- ---•----------•-------•....................•-•-•-•--......----------•---------.........._...--• ........... ...... .................................................. -•----•----•-------- -• --...--•--------••--• •---•--•-•-•..................... .....•-----------... ------•--......_.. ................................................... �Final Inspection by: ------------00 --------------------_..................._....Date _. . . . ............ ...... EH 13 2!t 1-1-68 Re /� Rev. 5I S N JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M