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a FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT Permit No. ..75�� (Complete In Triplicate) .................................................. This Permit Expires 'I Year From Date Issued Dote Issued Application is hereby made to the San Joaquin Local Health District for-o 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: JOB ADDRESS/LOC .............. .,. . . ....... ._....- Ltc �+.: �...:...................CENSUS TRACT ............._..... ...... h Owner's Name ..... -- •--- .....................................:...........:.........Phone .........................I——...... Address J ............. - ... ..---.......--•--._................... .. J ��O C�..........:. ......._... Y:� f �� ..... City Contractor's Name ... �a*- ----` License # .... .............................. Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court a 1 Motel ❑Other ....... `- -. ! k-�- -.. Number of living units:.__"`- Number of bedrooms .:..._.Garbage Grinder ........---- Lot Size Water Supply: Public 5ysteni'and nam8:---•---------------------------------`.._..........._.__....................._......................:..`.....Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ s 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 on reverse side.) �- NEW INSTALLATION: '(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT {.'} SEPTIC TANK :__X_`.. __._..__... Liquid Depth __.y.................... Capacity .J2 o c?...... Type Material--- Compartments —?.�............ Distance ..to nearest: Well - Q .........Foundation /..cel._.._..-_.. Prop. Line ...................... LEACHING LINE [ No. of Lines ........f............. Length of each line._______ 8 ..... Total Length 475� 4 r, 'D' Box I Type Filter Material .--_--s -------Depth Filter Material .....4`t 01 1 Distance to nearest: Well ........ .f..`...... Foundation ....._.�_0...�........ Property Line -_� .................. SEEPAGE PIT [i� Depth .......P-.,r._t_ Diameter Number -------/.................. Rock Filled Yes No Cl A- dv ; Water Table Depth Q ..........Rock Size __ 1 -_... `.3 ";Distance to nearest: Well .............. . . ?-- .............Foundation ........... Prop. Line _._r......_....... REPAIR/ADDITION(Prev. Sanitation Permit# ---:•....................................... Date ..................................I u SepticTank (Specify Requirements) .....................------------- ................•-----------..............--............................._---- .................. DisposalField (Specify Requirements) ------------------------------.-.-•------------•------•------•-----.-_..-•-----•-----------•--••---••-----------------•--------.----- ---•..........................----•---------•-•------•.•------------•-------•--------••--•--•-----------------..._.....------------......_......-••--_.._....._....._....--------............----.._...... -....---•------------------------------•----------------••----•-••----- ----------------------------------------------.._.-..--------•--•----.-._-.-•-•----•--•-------•--------------------------•--•---- {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 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, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ............................... .. Owner Title .. .- By --------------------------------------`- `-- 'c�, �:_.._..__ .- ...-------- --------- -------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ �.e .......................................------ ._....— DATE ....... ------------ BUILDING PERMIT ISSUED .................:... ...............DATE ADDITIONALCOMMENTS .......................................................•---......._.........._..............................._................................................ ------------- .....................................................,............................. ----•---•----•------------•---•---•-------------- •----- ............................... --------------- ....... ....... ......... ................. . -----._....„.._._. Date •,-1=' . . Final Inspection by: __.._ . !%;? Er. � ......................... y... SAN JOAQUIN LOCALS ALf�H DISTRICT E. H.13 24 1-'68 Rev. 5M 7/723m