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FOR OFFICE USE: APPLICATION F4R SANITATION PERMIT ' ' Permit No. a (Complete In Triplicate) ........................ ......................................... ... This Permit Expires 8 Year From Date Issued „ Date Issued r 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 Regulations: JOB ADDRESSAOCAT)ON �`Z.�"G¢....17•.1/l �';��/ ...... ..........CENSUS. TRACT ........ ................. Cwvner's Nam . ...`�?:�,.... ..._ ,j-�A, 2.?.. ..... .... .... .......................................Phone .................................... Address . / 0' ...:.. � .......fC/ -'? ...Clty ............................................................................ Contractor's Name ........-•.................................•-----......_..._._..License # ......................... Phone .............................. Installation will serve: Residence❑Apartnum House❑ Commercial❑Trailer Court ❑ Motel ]Other. .� ..-�%..-_'y'?---------..- Number of living units:............ Number of bedrooms .......,....Garbo a Grinder lot Size Water Supply: Public System and name ..............................,.......................-._.-...--..........................................Private ❑ Character of soil to a depth of 3 feet: Sand 13 Vt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe Q 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 INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 204 feet, PACKAGE TREATMENT ( j, SEPTIC TANK ] Size................................................. Liquid Depth .......................44 Capacity .................... Tyle .................... Material.................•---_ No. Compartments ...........---------. Distance to nearest: Well' ..___Foundation .., Prop. Line ?EACHING LINE ( ] No. of Lines ........................ Length of each line............................ Total Length ..........................£ 'D' Box ............ Type Filter Material ... .............Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ......................� SEEPAGE PIT ( ] Depth .................... Diameter ................ Number .....................:...... Rock Filled Yes 0 No Cp Water Table Depth ................ : . ............Rock Size .._.............................. Distance to nearest: Well ........................................Foundation .... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) ............. ................,................ ... .....................................,..._........_............... .0 Disposal Fiala (Specify Requirements) .........................L!?.G ...' ? ` `t . 7�! ?!n... p ... .................... ...................... ........ ..... ..-•..................::....................:................................... ..... i. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will he done in accordance with Sart. Joaqui County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iicen- sad agents signature certifies the following: "I certify that In the erforma e f the work for which this permit Is issued, I shall not employ any person in such manner as to become s to Work n's Compensation ! 4, of California" Signed ...-. . . . ....... •................. Owner By ................. -- ---------...............................................-........... title ........................................................................ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .,1 .- -....--- .... ...:. .................._........................ DATE ......:.....: BUILDING PERMIT ISSUED.....................................................................................I.....................DATE=.:......................................... ADDITIONAL COMMENTS.:=.,:.. :%�.....-..` _' ............................•--- •.---•- ....................---.. .-......-- .......:..-f _. ..A�. ..... .. final Inspection by:,. ...........•-.Date . . -./ ". ............•- ....... ........... .. ........... ...... EH 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M