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__ ----._ S F9 �FFICE USE! '�,' - �. , - -• s. - ---:._.-.._. APPLICATION i "SANITATION PBtMIT N, --•--• F- .............. (Complete in Trtplieafe) t Permit No. `.;P----3 ....:..................................... r .TNIs,Pennlf Deft $ Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Lows Health District for a permit to construct and install the work heroFn described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations; JOB ADDRESSA .-..Q--- �� ( U Owner's Name /2 J -- li -CENSt15 TRACT .......... ......._. Address ...- -- - - --D..__.. 1 Phone _...._.. ----------- l. Contractor's Name . -. _ _._.._....................... ----- --- ------ -- .::---.....License ��j�aJr` - phone Installation will serve Residence,� " a�rtment House �b�`� 0 Commercial ofraller Court � 4 Motel ❑Other. ............ Number of living units:....f....-- Number of bedrooms ot--- g.*.Gri•-de Water Su I ..Garbage Grinder'.t Lot Size f................ .PP Y� Public System and name --------------------------- Character of soil to a depth of 3 feet: Sand - --•'-•'_........... ........-------------------------- - - - Private gl--' )] Silf Q Gay Peat El Sandy Loam ❑ Clay Loam a t Hardpan 0 Adobe � - j�iF (9 Macrtete rial---�[? If yes, type--- .. ---. _-". __ _ '&(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) INSTALLATION. (No septic tank or seepageILA PACKAGE TREATMENT Pit permitted'if-public sewer is available within 200 feet,) o �SEPTICTANK e Y X r+.. / ......._I-- ---- Liquid Depth .. .-/?,rc_...,..... Capacity . _ .c_-CZE_,_ Type -nP_._ � Material. _'t VnZlY �No. Compartments ..:Z�' Distance to neast Well ._. -- - i "•"""'- LEACHING LINE - -------'---- --Foundation ....../,*......... Prop.gline , [�1 No. of Lines ---- -... Length J.A'.--•---:...---- _-- Lengih ofJ each H .. , :.?!�/-- Total !en th F...2.!-!-•_-_ 'D' Box /t-- a Type Filter Material ! /,�rl,sJ t� 4-••� / ? ---CL�6€pth Flier Material r Distance to nearest: Well .. -• Foundation lV SEEPAGE PIT j� r i --._.-...-.__..---.- Property Line 9a�......,_..__.._._ � Depth .4-_--_--.. Diame �.. Number _..... /�erC - •--•• ._ .......- Rock Filled Yes ®..^-po.� Water Table Depth - -...lCi..,-.L_.-.--.-.-_-._ - i - Rock Size ,1.,�.�...:.,.�.'. -•--- Distance to nearest: Well ...... eCr i S / .................Foundation _��---...__. Prop. Line;------------------ REPAIR/ADDITIONlPrev. Sanitation Permit--.----.....--•- - Date ...__.__.................._----1 Septic Tank (Specify Requirements! _ ---•,_........_------------isposal Field (Specify Requirements) ..._... = ---- ' .... ...... . .............. ._---.-- ._-..:--- -------------- -- ... (Dr _aw._existing.._. and required addition on reverse side) -- ! I hereby certify that I have prepared this dpplication and that the work will be done in accordance with San Joaquin 1 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 .. Owner (If other ------ Title . FOR DEPARTMEN USE ONLY ' APPLICATION ACCEPTED BY.. -. _.._.. - - - ~. ... - BUILDING PERMIT ISSUED......-------- ------ ------ ---.•..............---'--............DATE ------•--_-..- ----------_._ ADDITIONAL COMMENTS f f - ---------------------- - _._.. y -- ----------------------------------------------------------------------------------....------.----....................... . SAN JOAQUIN LOCAL HEALTH DISTRICT T�� E. H. 9 1-168 Rev. SM