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FOR OFFICE USE: APPLICA'TI'ON FOR SANITATION PIERMIT '-... {Comple4o in Triplicate). _ _a. ...... Permit No. ................... �. .. i Thls Permit Expires # Yeor From Date Issued Date Issued Application is hereby made to the-San Joaquin Loral Heal17istrict for a 40errnit to construct and install the work herein describer!. This application is made in compliance with County Ordinance o. 549 and existing Rules and d`~ .Z a......w._.l....�......... ._..._...... .,_ ` Regulations- 0 lations: s .....JOB ADDRESS/LOCATI Nn2 � . ......CENSUS TRACT ... .... •--•-- . ....T -Owner's Na � : 1�•--- .......... -Address .. ..:. 1 .....City . I Contractor's Name ..........5'-eJ-f........................................... ....License # ........_._. _ Phone Installation will serve: ResidencekApartment House Commercial OTraller Court 0 i 1 Motel ❑Other-----------•.... ..................:........ Number of .living units------ _... Number of bedrooms _._ ..._Garbage Grinder _.........-. Lot 5isu ..._��:�'G�--._---:____ Water.Supply: Public System and name ................: .......Private Character of soil to a depth of 3 feet: Sand' Silt 0 Gay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ �F Hardpan 0 Adobe'© Fill Materlol ............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 f ] Size..............:...............................:. Liquid Depth .................... yy Capacity T Material............................. No. Compartments Distance-t.to,nearest- Well ....................-----------------Foundation ................._.... Prop. Line ..---........r-...,., r 9 LEACHING LINE No. of Lines ._t�::_ ..--- -_--- Length of each line...._ 1 Total Length 'D' Box ............ Type Filter Material ...1%` -----Depth .Filter Material -------_6................. ` ._e.AZ�.... Property Line Distance oto nearest. Well .._��"�,....__ Foundation ._..-..... SEEPAGE PIT ( } Depth ............ pier ? . .,__. Number .:......._ —............ Rock Filled Yeso No 0 • Water Table Depth.- ok Si • ................ Distance to nearest-Well ...::__-- ''+r..._._... Foundation a. ._..._---- •-- Prop. Line ...................... REPAIR/ADDITION{Prev. Sanitation Permit# ..................................I..._-.__- Date ........................ Septic Tank }Specify Requirements) --------- ...&A..__w1:`5;. kV_a10 - .....:._5�- i�.Disposal Field IS ecifY Requirements) i -------------------------------------- ----------------------------------- ------ -•-• --:_ . ......... -••------------- -----•......••--........ --.._......... ............ IDraw existing and required addition on reverse side) 't I-hereby_certify that l-ho4e.prepared this application and that'-the work"will he 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: "1 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 �JectWorkman's Compensation .laws of CalifoinioSigned --- ----: 14!> ................................. ...... Owner BY -------------•-----------•----••-•--......__.-_._...._.. _-Title ._---------------------- 'f lIf other than owner) _ FOR DEPARTMENT USE.ONLY APPLICATION ACCEPTED BY .... . . _ ,. _... . --...... =-. .7� � �- ------ •DATE._.: BUILDING PERMIT ISSUED __-------------- f ---------------------------------------DATE _-. ---i--- ' ADDITIONALCOMMENTS ----- ---•----=--------------------------- ------------------------------ -------------------------------- ----------....:------••--•------_------- --------------------------------------------------- •--•---- - -------------- ---------------------------------------.._. ...._......_..........._........_•......._............... ----------------------•----•----•-•--- _.. j Final Inspection b Date ... .. .. ..._------- EH 13 2h 1-68 Rev. 5M l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M