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FOR OFFICE USE: APPLICATION FOR SANITATION PIERMI11 Permit No. .- 6.�.......... � (Complete In Triplicate) _. p Date Issued .1 This Permit Expires 1 Year From Date Issued ------- JLocal Health District for a permit to construct and install the work herein Application is hereby made to the San Joaquin i described. This application is made in compliance wig County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION .. �� f ...CENSUS ... . ......... . ._ ...._ - .::.:..._ RN. � •� ......... .-•-• Owner's Name -- 1- - � - l �- Address _ . :.:../P;Z.��A �'� '(��_ / - �-.�...............• . City ' � TGA! � ....._.... _ ............- I 'I L' ....... ...........License # 1" . .. Phone ........ . Contractor's Name _..__ -�..-- ��•----• ->� � .... Installation will serve: Residence []Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other .............•------......------....•--_...- Number of living units:-.-/ .. Number of bedrooms ---..Garbage Grinder _.c. i Lot Size .��..��.-'.-.�- .:... _ Water Supply: Public System and name .......................................................----------•.........................• - ........ ..-- Privateco Character of Boit to a depth of 3 feet: Sand ❑ Silt[3Clay ❑ Peat❑ Sandy Loom ❑ Clay Loom 14t 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 is available within 200 feet,) f • — PACKAGE TREATMENT [ ] SEPTIC TANK Siize_--. ..._X..!- ✓.•x��--4• Liquid Depth . ................• ° ` Materials /,7.& .. No. Compartments ..-.r�.............. n Capacity T e,� 1' Capac� YP �' � ..Foundation .1,e� ---- Prop. Line Distance to nearest: Well __�-- --•-.--------•••••----• --- �------ -.----- Length of each line---- --•---.. Total Length .../. ..___....... LEACHING LINE d Na. of Lines -.- Z I 'D' Box &=�-. Type Filter Material l rDepth .Filter Material ./ .................. Distance to nearest: Well .,C.f._ �_......... Foundation _ - ----•----.... Property Line ..�� ... <`' -_--. Number ------V•------------ Rock Filled YesA No (] SEEPAGE PIT Depth -- s�---�---. Diameter /r -•-------...Rock Size Z�...... �a Water Table Depth -.._�� r Distance to nearest: Well ---- ........----Foundation . Prop. Line _-- � � �I R>=PAIR/ADDITION IPrev. Sanitation Permit�# -.-...-- ----------------------------------- Date ----------------------------------) f � . Septic Tank (Specify .Requirements). ----------------- ---------••-- - . Disposal Field [Specify Requirementsl ---------- --------------------------------- -------------_----_----- ---------------------------------------- --------------- -------------------------------------- .-......_.. ------------------------------------------------•••---- ------ - ------ -- --- ------------------ ---- -- - (D- raw existing and required addition on reverseside) 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; person in such manner "I testify that in the performance of the work for which this permit is issues!, I shall not employ any as to become subject to Workman's Compensation laws of California." (I r # n ol --------------- Owner --------------SignedTitle . hoer -- -- __ -- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---.- /L1.--- DATE .... ... . :... .. .... ... BUILDING PERMIT ISSUED ------------ ----- __..------------ ..- -----....._DAT£ ..... .... ADDITIONAL COMMENTS ----------------------------------•---- ---------------------------------......--.......---...---....- - WWI........................... ----------- r� ------------ - -- --- ---- ---- ------ Date Final Inspection by: --.----- � '-1--------- EH 1 2 1-66 Rev.I 3 SAM JOAQUIN LOCAL HEALTH DISTRICT 8/7lt 3M