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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ............ ...._._...-- ... •• (Complete in Triplicate) Permit No. ..................... This Permit Expires 1 Year From date Issued Date Issued _37-37...7J. Application.is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i. described. This application is made in compliance with County Ordinance N S49 and existing Rules and Regulations: c` r JOB ADDRESS/LOCATION .-...._��1.1.2� S' ----�� CENSUS TRACT .......................... Owner's Name d�.�.i__._.....-_....- Phone _. / ----- Address --.._...:..:1..q-! (- •� 1 � 1 :--•----••---------------------------- City _.. ------------1........... r Contractor's Name .......... _ License # ... Phone __.-....._.. Installation will serve: Residence Apartment House❑ Commercial []Trailer Court C] Motel ❑ Other ...... ------------- Number of living units:-... ------- Number of bedroomsi7_ ._....-_Gorbage Grinder ............. Lot Size ...-....____..__-- Water Supply: Public System and name ..._. ._--••,--_- ....-----. - ❑ Character of soil to a depth of 3 feet: Sand❑ Silt Clay! [I eat❑� _.._._.-Private Sandy ----••- -Loom ❑ Clay loam ❑ r Hardpan ❑ Adobe ❑ Fill Material ._.. .--... If yes,type .-~..'..... ...... ... .�._ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed onl reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT w ".y:. # ( ] SEPTIC TANK ] Size.----- ••---- ---:.__. _.�.....-.__... �_.._ r �l.iquid Depth -----------------•-------- Capacity .. (�� r Type . • - Material'"" .._.. \ -..-.. No. Compartments' -• ----•------- Distance to nearest: Well .........--•.___ - ----_Foundation ,..- ...-............. Prop. Line ..-------._.......... i 6 LEACHING LINE [ ) No. of Lines - -- - _..- Length of each line....,_- ......��`_ } Total Length ...:- ... D' Box ._... Type Filter Material ---------_........_Depth Filter Material .._................... N Distance to nearest: Well -----_-__------------- Foundation ........'.-.._ .. Property Line i---_- SEEPAGE PIT } 1 Water Table Depth _ R �, -, Rock Filled Yes ❑ No ❑ th :..nep ..-..-„..,�... Diameter _------------- Numbe. ....... ...... . ._ P . •- odc Size ...------' Distance to nearest: Well --------------- ...............Foundation ...... .. ....... p•Pro line .........Prop.-` s REPAIR/ADDITION(Prev. Sanitation Permit# --------.--- ---------- ----------- -_ Date ------- -----I i Septic Tank (Specify Requiremenfs) -:.....- '-_�•--_--.-! "'i 1 ---_--•- i r ................ Disposal Field (Specify Requ'irernents) _ �' X � i ---- ..................... p - - .................. �- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application l and that the work will be done in 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: k "I terrify 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 sub, to Workman's Compensation laws of California.” Signed .:_ - •--•-------------- Owner • By .... ..... .... ......... Title . ... .. ... (i other than ------------------ -- owner} ��•-• � O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . :- ....:-�..................... . - ............. .....................PERMIT ISSUED ------------ --- - .. ............ ............................... .......•-- Final Inspection by: -.___--------- -------- -----I....... ........:... ............................... .... -----61 --_-------------- ... ..........____------------------_----- -------Date ............ SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24. E. H. 1-'6$ Rev. 5M ., ,.. .. _ „ ..- rte... •�,. _ - _�__ ., -_