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" FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT PermitNo. ..� -��a/ ........................................................ (Complete in Triplicate) Dare . ........................ p issued .�G�. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a .permit to construct and install the work herein App ' s described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. J�1�. - .. ......... . ... .. :'._.._................-..CENSUS TRACT�............... .......•.. JOB ADDRESS/LOCATiO ......... ...... .... �. .......Phone .................................... Owner's Name ...... ....---i -•• - ........ - •-•---•-•-••- .. - ...- ..�.----�..�-..,.p.. C_.a-.._ •- Address . ._. . . . .. ;= city ..• --- --- . ........................................... : ..........License # -/�r -Y. Phone ._ Contractor's Name ...... Installation will serve: Residence �A artment House 0 Commercial❑Trailer Court ] .Motel ❑Other ..............•----....--- Number of living units:...I......_ Number of bedrooms _........___Garbage Grinder ..__...___.. Lot Size .................. . _- _ -.............{ � ..................... ------- - , , ...................................................Private e Water Supply: Public System and name ....................... Character of soil to a depth of 3 feet: Sand'❑ . It❑ Clay ❑ Peat Sandy Loam 0 Cloy Loam ❑ Fill Material _._....._.._ If yes,tyPe p�l - � Hardpan Adobe ❑. (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,} -- Liquid Depth SEPTIC TANK i Size.------•. .......................... PACKAGE TREATMENT [ 3 CapacityType aterial_._... ....... No. Compartments ...................... --• pro Line .. earest: Well _..- ....................._.. Foundation ................... p. ` Length of eaeh 'line......................__.._. Total Length .••-............. . LEACHING LINE [ l No.. of Lines --.•-- Distance o n 'D' Box Type Filter Material .Depth Filter Material ................................... C� --..--:- Foundation Property Line ------_---•-•-••••••• Distance- to nearest: Well .:............ . -.._�•..--- --......-•-- SEEPAGE PIT [ ) Depth ................. .. Diameter Number .........____......... Rock Filled Yes ❑ No Q Water Table Depth Rock Size ------------------•--•---------- ..Foundation ._..._. Prop. Line _.-----------•........ � Distance to nearest: Well - --• --"""•---' REPAIR/ADDITION{Prev. Sanitation Permit# ...................•..........••-•...... •- Date ---•.............................. Septic Tank (Specify Requirements) ........... ------------------------ •----...--•---..........._-_--___......... - Disposal Field {Specify Requirements}. ....� .....� t. ...... - ..................................................... - -----------•--------•------- ------ ..............................•--.... ...................... ••- (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: "1 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 n...:.. ::_._.. Owner -------------- By ................ ---...---._._........-----• -:. - title .:.. ................................................... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............... ..................................:..................................... DATE ...../fZ .. ........ .....DATE ..................... ..................... BUILDING PERMIT ISSUED ADDITIONAL COMMENTS .......... .. ................ - ......................... ....------•--•____. i -•------...--------------- ------------............................. ................................. ..•----_......----•-•------_•. :...-----_.....•.---•.----.-• ...........'_-....-.Date-------------!r .............._ Final Inspection by: _...____.. _ SAN JOAQUIN LOCAL THEALTH DISTRICT _ . . 7/72/72 .. 7 'A 94