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FOR OFFICE USE: --• ---:.._............... APPLICATION FOR SANITATION PEP-MIT 77 pS iComplete in Triplicate) Permit No. ..----......_......_. .......... This Permit Expires 1 Year from Date Issued Date Issued .:!;?�:/:.22 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 mocipgcomplionce ' h County Ordinance No. 549 and existing Rules andReg latlons: JOB ADDRESS/LOCATION ..... .. . CENSUS TRACT Owner' p s Name. .'�.�.�� --�----� Y... . .......- Phone c� �� • Address .. :,- City ,, 4 . ...... .... Contractor's Name _ �... _ ..............License ill 302_2 2_2..... Phone l Installation will serve: Residence partment Housefj Commercial ❑Traller 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.❑ Clay ❑ Peat❑ Sandy Loam 0---'Clay Loam ❑ Hardpan 0 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 ( I SEPTIC TANK IT ] Size................................................ Liquid Depth .......................... Capacity ---•---------------- Type --------..---------- Material.._.........__....... No, Compartments ' .J Distance.to nearest: Well --------------------------- ..--..Foundation ..... Prop. Line ...................... LEACHING LINE ( j 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 2......................... Rock Filled Yes ❑ No (3 y r Water Table Depth ---------------------...........................Rock_ Size ......_..---------............__ C Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ...................... M REPAIR/ADDITION(Prev. Sanitation. Permit=# ....................--------------•......... Date............ .--:•----,....-, j�.: . � �, Septic Tank {Specify Requirements) .......................................... _.. Disposal Field (Specify Requirements) ...------ ��_----- ✓f�� ', jPc.---------' � 'y ------- ............. ---------------------------------------- ...........•------.. ......... .........--------------------....--------------._........----_.._........................................................... (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Name owner or licen- sed agents signature certifies the following- "i certify that in the performance of the work for which this permit is issued, l *hail not employ any person in such manner as to become sub ect to W rkman's Compensation laws of California." Signed ---•----- - - ---- --- -----------------••---•------------• Owner By ........ z" - ---- Title -... •----�y_..--- cam... ..- � (If other than owned ' FOR DEPARTMENT ]USE ONLY APPLICATION ACCEPTED BY ------ `..Dj_`_.. .__ .-_._._ ------ DATE ,, .. 1-- --:,.--------: BUILDING PERMIT ISSUED .._...._ _ ----------DATE ......................... .................... ....... -- -----...--•�---•-•---...------�-----...._ ................. ADDITIONAL COMMENTS ............. . .----•--. . .. .... ------ .................... ---- - - ---- .... Final Inspection by:---------.........- pate -�'/..1.� -- _ � 13 24 1-68 l�v• � 'A Q* LOCA! HEALTH D15TItICT 8/74 3M r