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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit o. ..................... ............-........-........................... ,,. ......................................................... This Permit Expires 1 Year from Date Issued Date Issued Application is hereby made to the San Jooquin-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: 11 1 J08 ADDRESS/LOCATION .........................................._..1....._.._........,......................CENSUS TRACT ......-.-........... ..._.. Owner's Name !vv BIZ I e ti G. Phone �. ............ I...,.......................--•.._' ......... .........-................ Address ....'- ....................I—'........city . . . . ................................................ Contractor's Name _ 5� .._.... _4.+��...............................................License # a. $ -1 b...... Phone ...° .3 .6.._ Installation will serve: Residence Apartment House f-] Commercial OTrailer Court 0 Motel ❑Other ...... .......................••_........••• Number of Jiving units:............ Number of bedrooms . ......Garbage Grinder ......__.... Loi Size ....--..........•._.......................... Water Supply: Public System and name ..................--------------------------------------_..-.._....::........._..._....._..__................Private Character of soil to o depth of 3 feet: Sand o Silt o Clay o Peat Q Sandy Loom ey,Clay Loam 0 Hardpan&010' Adobe 0 Fill Material ...._....i.-if yes,type............... ............._ I (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.--- 0.__...S_ .. .."!_" ..._. Liquid Depth ----- •................. . Capacity 1.00 aType el_------- Material Oe ms._n`�.... No. Compartments .. ............. Distance to nearest: Well ------------------ ................Foundation ___3P_�.. IUO + .......... Prop. Line ....................J LEACHING LINE [ J No. of Lines ....t._.--------------- Length of eachline,._..1 .�_• ............ Tota! Length .._•.tV�?.�---•--..__.r tor— 'D' BoxType Filter Material Ce►,,e,.wDepth filter Material ---t-�......� c Distance to nearest: Well _!5________________ Foundation J';...._....______.._ Property Line ... U..... .. . . . SEEPAGE PIT ( ] Depth ..14-1------------ Diameter --------- Number _aC).... 4SRock FieYes -y� ................ Filled No '� Water Table Depth -.-+lo-n_e----------------------------------Rock Size ----[-s_....................... r/ Distance to nearest: Well ---------------------------Foundation __3_.�:----.----- Prop. Line ..C)......,.._ REPAIR/ADDITION(Prev. Sanitation Permit# -•--•-----------------------------•-- ...... Date .................................. Septic Tank (Specify Requirements) ................................................... ................. ........................................... 7 Disposal Field (Specify Requirements) ---------------- --•-------•-• -•---•---------------•-----.........--•---------._.____._-------•----._-...................... � ---------------- --- - -------------•-----_----------•--------•---•--------....--------------.........--•-• ................................................ (Draw existing acid required addition on reverse side): -- -"- V I hereby certify that I have prepared this application and:that the work will be done in accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner or Ilcen- sed agents signature certifies the following: s "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 subject to Workman's Compensation laws of California." Signed ---•------- --- -- Owner By ----- '� _q_u --------------------- --------------------• Title _.�0�214�a v.1 ��ct 5`��.� �n.. '• ..._ (if other than bwner) FOR DEPARTMENT USE ONLY BY BUILD NGOPERM TCEPTED ISSUED ...... ".--------------------------------------------------------------;--. . ------------------------- DATE .. .�� ...--t_�_ -----------------DATE ...... .---._...__ .........-... ADDITIONAL COMMENTS ------------------------ ---------•-••--------•--....----••--•-------------------------••............................._........................ ----------- ........ -•----•--------------------- . Final Inspection by: ----------------- - _._... - .............•............ ,w..;. __- _.. _-------Date ...��.:.�.�;_...:.�E�,�'"" EH 13 24 1--68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M