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FDR OFFICE USE: 0 o APPLICATION EOR SANITATION PERMIT Permit No. 2. ................. (complete in Triplicate) 5...-. ... This Permit Expires I Year From Date Issued Date Issued 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 Comy rdinonce No. 549 and existing Rules and Regulations: JOB ADDRESS/ AT N ..---- ..._._._ T rP .....................CENSUS TRACT .......................... Owner's Namfd" ' Phone Address . . City ................. Contractor's Name ___ C. ....License #� 7, ..� Phan Y T Installation will serve: Re si encs❑Apartment House Commercial OTrailer Court r] Motel ❑Other ............ ................... Number of living units:---- ----_ Number of bedrooms .._9-..Garbage Grinder ............ Lot Size ... .... .. Water Supply: Public System and name .....Private 0— Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat 0 Sandy Loam 0 Clay Loam M. Hardpan ❑ Adobe•❑ Fill Material ............ If yes,type ............... ............ (Plot plan, showing size of lot, location of system Jn 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 208 feet) PACKAGE TREATMENT [ ] SEPTIC TANK 1 1 Size....................... ....... Liquid Depth .......................... Capacity __________________ -. Material-------------___. . p NoCompartments t . Type ...._...- .........6 Distance to nearest: Well ....................................Foundation -----------............ Prop. Line ............... 6 LEACHING LINE [ I No, of Lines I--------------------- Length of each line...- A............ Total Length ... d ._........ .._ . 'b' Box ............ Type Filter Material ....................Depth Filter Maternal ........................................ Distance to nearest: Well ....... ®.. Foundation ............ Property Line SEEPAGE PIT Depth �_. x Diameter ._..___._.-•_--- Number .._. ........... Rock Filled Yes Na 0� Water Fable Depth --------------------------------•-------------.-Rock Size ............. ................ Distance to nearest: Well ........................................foundation ..................... Prop. Line .......................P REPAIR/ADDITION(Prov. Sanitation Permit# ..__.._............. ........•-••---...-__ Date ..........._. .................... Septic Tank (Specify Requirements) ...................................................__..............._ ........................... Disposal Field (Specify Requirements[ ------ f -------------------------- .......... .............. ----------------- •----- -----••- .. (Draw existing and regGir`ed addition on reverse side( 1 hereby certify that I have prepared this application and that the work will be done rin 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: "I certify that In the performance of the work for which this permit is Issued, 1 shall not e:mploy any person In such manner as to become subject to Workman's Compensations laws of California." Signed ----- - Owner By ... •----- �.. . xitle ------• --- ... ..................... (i of er than owner! 4 FO PARTMENT -U ONLY APPLICATION ACCEPTED BY _ .------. DATE . '. - _-•"- ...._ BUILDING PERMIT ISSUED .................... --------------DATE .-.-..-.-.-__...__. .ADDITIONAL COMMENTS -.-• -------�---- -�---------------�-....-•------ ---- -•- -----�-----•----•--� - ....... .......•-.•-•----- --------------- .-----..-•-•-•................ ~j.. --- --- -- --- ..>� _:� p,r... final Inspection by: .._.__•- - - - --------••-J._--•_©ate ................. I' ---•--------•---• -•-•••---...._.._......-- ......... EH 13 24 1-6f3 Rev. Sit SAN JOAQU LOCAL HEALTH DISTRICT 8/711 3M