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FOR OFFICE USE: APPLICATION FOR SANITA + _ T10N PIT �. --- . -- ----- (Complete in Triplicate) Permit No. ' ....... ------------ ------------------------------ - This Permit Expires 1 Year From Date issued Date Issued 7� f_7Y 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 existin JOB ADDRESS/LOCATION ..__.. - GENS TR Pawns: Owner's NamePhone rJ -- ----- Address --- --- - " City �1�:- Contractor's Name -..------v"� --------------- - -----.License # ------ Phone I installation will serve: Residence ❑ Apartment House,n Commercial :❑Trailer Court ❑ Motel ❑ Other Number of-living units:--_-/_.__._ Number of bedrooms —_--Garbage Grinder .._- ------- Lot Size _--______....____-. Water Supply: Public System and name --- ------------------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat 0 Sandy Loam [r 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 is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK [� Size-------------------------------------------------- Liquid Depth .................. . Capacity --_J z -o.0'_._.-_ Type��'-��- �__-- Material..C¢-r..�✓��-- No. Compartments ----- y Distance to nearest: Well __s. d-�f____________________Foundation ---------------------- Prop. Line .__. ........... LEACHING LIME - [ =No. of Lines ---A_-------------- Length of each line.----- '_.�� Total Length l D': Boxe-------- Type Filter Material -Depth Filter Material ------------If....................... Distance to n rest: Well --- Foundation Foundation __.--------------------- Property Line . Depth et J ..__ beY a ! /Yes Water ate pt i Distance to n st: ell ------- ----- --- ---- •. • .......... dati •----_- Prop., Line .............--• •- tEAiR REPAIR/ADDITION Sanitation Permit# ------ ---- ------ ------ DateSP (Specify i Requirements) --- ---•----------------------------_------••-------- --- Disposal Field (Specify Requirements) .______________ __ I ---•--------- ______________________-_._._ - ; f ________________________ - ________.__._-.__._______._._.._______-_____-_-____.__________--_._._____--___..__-- ---.____.___.-------------------.--------------------._-"-______..._____.__-__ __________________________________________________________ (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 San 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�s/ub'e to Workman's Compensation laws of California." Signed �b B - --`-�-�'1 '-------- . Owner � Y ------------ ---------------------------- Title ........................................... (If other than owner) _AOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------- - -" _-___.__.._-_ -� r2� BUILDING PERMIT ISSUED ---- -"----------------- --------------------------- DATE .._ Y •----------- DATE ADDITIONAL COMMENTS ---•---- ----- .. - ------------------------------------------ ----------- _..._. -- Final Inspection by: ------- --- ---------Date . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9' 1-'b8 Rev. 5M