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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................... .............. (Complete in Triplicate) Permit .:........... This�e�innt Expires T Year,Prim Date issued Date Issued Application is hereby made to the San Joaquin Locallleolth District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: J08 ADDRESS/LOCATI N ,..of.9 l yrl� ___...,�'rfolO c ......I-e ........:...............CENSUS TRACT. .........:._.:....... ..... Owner's Name .�I .i....•..��.��, . ....................... .......................................................Prone'.-------- Address ..... � f 'fes......................... :..._... `. ............. City . '/Ls4° �f..:----------. ... ......... ........., d Contractor's Name ®i,1�—� ...License #p�7. �./�. Phone .fe .*0 ,, ezZ Installation will serve: Residence ❑Apartment House fl Commerciol)X)Trailer Court 0 Motel ❑Other ...........--`.............................. Number of living units:_.'..... Number of bedrooms .:-nT=.Garbage Grinder ..Af. Lot Size 9--~��./`srr ............ Water Supply: Public System and name. ---.................."------•---. - ---------- -------------------------------------------- -- Private Character of soil to a depth of 3 feet: Sand'❑ . Silt❑ -Clay 0 'Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ........................... . (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc: must be placed on reverse side.) NEW INSTALLATION: (No septic tank or.seepoge pit_ permitted if public sewer is available within 200 feet,) ,.-./ PACKAGE TREATMENT ) ) SEPTIC TANK ................. Liquid Depth ,s ................h,� Capacity/2401 ..... Type IA -_�,�_ Material .::. No. Compartments �— V Distance to nearest: Well -:_AeZ.....................Foundation...447........... Prop. Line :rte-�_............ N Q LEACHIG LINE No. of Lines _. Length of each line---/p . ......._.-- Total Length f��. .............. ` 'D' Bax y.,.-_ _--------��. '` .� /.�o4_.. Type f=ilter Material .�� d&epth Filter Material ,l ..........................:--...:_.. Distance to nearest: 'Well ..A&7......... Foundation ....... Property Line .. .................. SEEPAGE PIT ( Depth ...... Diameter -- it .:.... plumber ...l._.. ............... Rock Filled �Yes,�' No C] /! /� Water Table Depth ��' Rock Size, Distance.to nearest: Well _ ,� ..- •..........:...........•-- •-----•--- --...�--• -•---- QFI :_._.Foundation .* Prop. Line ------ REPAIR/ADDITION REPAIR/ADDITION(Prev. Sanitation Permit#_.:......................................... Date ................... .......... Septic Tank (Specify Requirements) ...........)............. ......................... --....._....----------......----•----.........._........--------•-------- Disposal Field (Specify Requirements) ........................•....................I-------- ------------............................................................... ............I....... •..............................•--- --------------..........-.__...----- ......_..................... ................................................................ ... (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 Son Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that.in-the Iierformance-of-the work for-which this permit is issued, I *hail not employ any person in such manner as to become subject to Workman's Compensation laws of California." {. Signed -------------------- ----------- Owner BY ....................._.:..... Title ............................... ei than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ ..... .. ... .... .. .....................................•-•-•-----.._..----.. . DATE ...... .. ..2.z..?.. ....... BUILDING PERMIT ISSUED ...........L,.__=..- � ._DATE ADDITIONAL COMMENTS ................... ............-...................-...............-................................................___.....................................................----....---•• ------...--•-- ..._....... -•-----••..........................•.----••--- .... ::... . .................................. .................••........ _. ..•... -•----....... .................................... . . -------------------- Final Inspection by: .................. .....-.....Date SAN OAQUIN LOCAL,HEALTH DISTRICT TM E. H.13 241.'68 Rev. 5M 7172 3 K