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�f APPLICATION FOR SANITATION PERMIT FOR OFFICE USE. .... .... ........ ...............-•- Permit No. .:7,.3-/.� (Complete in Triplicate) •-•-----• .......... ............. This Permit Expires 1 Yeas from Date Issued Date Issued �� :..7 . Application is hereby made to the San Joaquin local Health Districf for a 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: Q /J JOB ADDRESSAOC ATI N ..-- CJ��_f...._.. 0-iii, fG--..1G--o...`..............................CENSUS TRACT ...................... r'R "... _�.4Ca�!........................ ...............................Phone 7 ` ........ ! Owner's Name f?_S�-L�>�-, Address _..::._ City ----------•.................................. ---------- Contractor's Name .... : ._'_Pr:`: .. "r��{t. y-.�-��.......__... License # _3`F Phone _ 6..=1.� `,�'.=.... Installation will serve€ 3 Residence { Apartment House:❑ Commercial []Trailer Court—[j— Motel [] Other • . . _.. --- - k Number of living units:.......... Number of bedrooms _: ......Garboge Grinder .......... . lot Size. ...................... Water Supply: Public System and 'name ------------- ------------- ........... ........---............---------- ....................Private Character of soil to a depth of 3 feet: Sand ❑ Silt'❑ Clay Peat❑ Sandy loam ❑ Clay Loam ❑ Hardpan ❑ Adobe.-C] Fill Material ............ If yes, type ....... .............:....... (Plot plan, showing size of lot, location of system in relation to wells, buildings,,etc. must be placed on rev rse side.) NEW INSTALLATION: (No septic tank or seepage"pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK' i : �� [ � � � -h= Size............. ---.... Liquid Depth ._._.-�-•'---...-- �I Capacity . . Type .--_.. ......... Material................,---_. No. Compartments ..__ ............... pq NoDistance "to nearest: Well ............................Foundation ..........._...._.... Prop. Line ..- .................. LEACHING LINE [ Lines Length of each line ........... ................ Total Length ........................ „ Type Filter Material ............. ......Depth Filter Material ............................. Distance to nearest: Well ........................ Foundation Property Line -.------- SEEPAGE PIT [ # Depth - ;rl - ------.- Diameter Number Rock Filled Yes ❑ No [j 3 F 4 Water Table Depth .............. •-- ----• ------Rock Size ................................ Distance to o nearest: Well -----•................. •- •--•........Foundation -------- ----- Prop. line .............. REPAIR/ADDITION(Prev. Sanitation Permit# ------------- -... Date ---------------------------------- Septic Tank (Specify Re uireme ............................................................. Disposal Field (Specify Requirntsl -._----- -.----- �-••---•--- ---------------- .......................... Requirements ------` ---r3...__.� �a.�1 ` !'�.. rp I ----------- .. . .. ... . - t , (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 Workmanfs Compensation laws of California." Signed ............. Owner�� -^ By ..... . .. ........... .... . .. .....--- Title �. r ................. ..... (If other than owner) _ O DEPARTMENT USE ONLY E 1 APPLICATION ACCEPTED BY' .. . .... --- .................. ..-----... - - ......._.. DATE . J', .._....... BUILDING PERMIT ISSUED _... ... - --------•--- ..............DATE 11DITIONAL CO +1141NT5 :1. ._ / .... .. ............ ..�....: ... .............. ------ ----------- .-.......�....... , - -- ---------------- .......--- --- -- -------------------- .................................... Final Inspection by: . ... Date AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1- 68 Rev. 5M