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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT .......................................: 76 AGN' (Complete In Triplicate) Permit No. ..................... This Permit Expires 1 Year From Datelsseed 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. 549 and existing Rules and Regulatlons: JOB ADDRESS/LOCATION ...t .e-v,./.4s�....G-,c_.J_':Irf.:�W .-,Zd...................CENSUS TRACT .......................... ' Owner's Name y •s��"P.c f'......._...__.•.city �a�l`r��c�� •.................................. yrs/....,.��G/ ,s? . . -................... Address ----•- --/.-�OI�..�j.�SA.•.�...�- ..,rF'G� �_ .......... Phone............._._..................._... Contractor's Name-... � �v�{y7� Phone ..�..................._..... ' installation will serve: Residence❑Apartment Housefl CommerclaFnTrailer Court ❑ Motel ❑Other.......-----....... ................. ...... Number of living units: Z.... Number of bedrooms .%Y.....Garbage Grinder z1e,."r/. lot'Size-.q.E'%fY.*- - � Water Supply: Public System and name ------------............................................_..........................._...._•._.._...._.....Private I Character of soil to a depth of 3 feet: Sand o Silt Q Clay ❑ Peat❑ Sandy Loam Q day loct�(dovd`)4 ' 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.) V ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) / PACKAGE TREATMENT SEPTIC TANK Size I J �`--/�._X.-1rp- ----- Liquid Depth .�� _. .._.... Capacity 1�.� .._._ TYpe y��' Material G> 1�>�l f/,... No. Compartments ......Ann! ..... n ' Distance to nearest: Well ..��.. ..1................Foundallon .f F�.�.------. Prop. Line ... Q�f. LEACHING LINE No. of Linea ............ Length of each line.... 6? '� . Tocol Len D' Box l Type Filter Material %4-4.G. Depth Filter Motorial ............................. Distance to nearest: Well ...... Foundation ...... Property Line .-.-Z-4`'.e.-".-.� SEEPAGE PIT Depth ... Diameter Number ...... ..... ....... Rock Filled YesA No C3 Water Table Depth ..._.�.��..._...•......................Rock Size Z...iTM..s.I�...N.....__._.p Distance to nearest: Well .._.��_ � ..................Foundation . _...�!Q...... Proline ... ...... REPAIR/ADDITION IPrev. Sanitation Permit# ............................................ Dote ........_.........:_............. ' Septic Tank ISpecify Requirements) ........................................... ......................................_.......................-............................. Disposal Field (Specify Requirements) ............................................... . ......................................•---._.._...._._....._.._......__......._.. -- .....-. - -- ........_............................... ................... .......... ............... .................... ............................................ .................. •••- (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 Ilam 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 ..................... ... s::.._... ..................... Title -( - .-......................_ p r than o nerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-..-.. ._ _. . DATE . ,L: _ ..'2. . . .. ......................... . . ................ BUILDING PERMIT ISSUED .... .. .......::.. . ................ ......... - '............._.........._...... ---DATE ........................................... ADDITIONAL COMMENTS ............ ................ .................--_.......................................-......................................,........................... ................ ............................................................................................................................-......-.............---•-----........._......................................................... ...............c-� Final Inspection by: ................. ,f Date ......71:58.. .. ..�........... EH 13 2h 1-68 Rev. 5M SAN JOAGtUlN LOCAL HEALTH DISTRICT (! 8/7h 3M