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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .. 7`:' ...... �7 ...... This Permit Expires 1 Year From Date Issued Dote 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 County Ordinance No. 549 aide i g Ru Mations: JOB ADDRESS/LOCATION �� ..__ .. :..a._----1 . �-...... . ......_....CENSUS TRACT ty........................ Owner's Name ............ -----•-----t -•-_;V- - = .......:.... ...............Phone�'_�_t?'.�~�--�-• Address ..._.. � ......... .. --- City � . . �.-.> Contractor's Name .. �: ,¢ ?_. -!&,.mss ilricense # �I�'I. Phone 4. 7.,5S?........ Installation will serve.=-- Residenc'eXApartment House] Commercial ❑Trailer eaast Motel []Other .................................. Number of living units ..... ___... Number of be ooms _.q g Garba a Grinder __.: .. LOt Size .---�:--_— ...., •............... Water Supply: Public System and name '"..__ -------- ,C _. C ------------------------- Private * Character of soil to a depth of 3 feet: Sand O Silt 0 Clay [] ' Peat[] Sandy Loam 0 Clay Loam [] Hardpgn9 - : Adobe 0 Fill Material -____.____-- If yes,type ____________________ ------- (Plot plan, showing size of lot, location of wsyst�m 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 .A.10. ...... Liquid Depth .....4.................. Capacltv1 Z�.__1 rTYPe 4 Material. = - Na. Compartments .-..2.1............ Distance to nearest: Well _ 4? `�..................Foundatio --------- Prop. Line LEACHING LINE No. of Lines _P..._.._.... ntal Len Length ./a. .. .. Length of each line..--.�i 9 • .. •----• 'D' Box ../-•----- Type Filter Material ..Depth Filter Material .. .. ...........................:.•: _ f r Distance to nearest: Well 1AJP.:_�_�._._....._.. Foundation .. 0.............. Property Line �,j .......... r ....._ Rock Filled Yes ( No C) SEEPAGE PIT Depth .��.:�.---•_-- Diameter '��..�.��_. dumber _._.._�......._.._ Water Table Depth 45)C-------------------- -----•..Rock Size Distance to nearest: Wel( __i...................Foundation .................. Prop. line ......................... REPAIR/ADDITION(Prev. Sanitation Permit# ... Date Septic Tank (Specify Requirements)-.....----------------------- ........ .......... Disposal Field (Specify Requirements) ----------------------............................................................................................................ . } ...............I-------------------------- ---------------------------------------.--------------------------------------------..................................--------------..........-•-.-........ . ------------------------------------------------ ---- -- -- ----- ---- --- ------ --------- - (Draw existing and'r'e'quired addition on reverse side) 7 I hereby certify that 1 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 liven. 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 f as to become subject to Workman's Compensation laws of California' Signed -. f Owner I B Title ...... �lf other than owner) /J FOR DEPARTMENT Ili ONLY APPLICATION ACCEPTED BY :'7"' --------- ------------------ -- DATE . BUILDING PERMIT ISSUED ............................................. .. ......_-• ----DATE ........-- •• --• .................... . ADDITIONAL COMMENTS .r,, ---------------------------- ...................... --- . ------..................... ----------------........----......--- ................................. :....__ --- ...._. . (� IT Final Inspection by" ....:.... ... ... ... DateC�.... .... ". ... F Mir A JOAQUIN LOCAL HEALTH DISTRICT k E. H. L3 241-'b8 Rev. 5M 7/71 1 u