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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT w •----•...................... .. ..Permit No. . 7 S... Y S (Complete in Triplicate) ............................. KANN This Permit Expires I Year From Date Issued ERissued .................... Application is hereby made to the San Joaquin Local Health District for a per to construct and instaii the work herein described. This application is madded in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,: .. /� ..... .._ _. _ CT .......................... _. CENSUS TRA Owner's Name ... if ......... ............Phone ......................••••.......... Address ._... .7f .............. City -- — Contractor's Name . = E.•••: ............License # .L�$��` .. Phone ............ ...:..... Installation will serve: Reside Apartment Housed Commercial :❑Trailer Court ;❑ f Motel ❑Other ----------__.......... ............... Number of living units ........ Number of bedrooms ._.....Garbage Grinder ....____.... Lot Size ...11 .. . .................. Water Supply: Public System and name _......................-----•---....... ._...-•--- ---.._..-•---••--•---------- ..__........Private f Character of soil to a depth of 3 feet: Sand❑ '.Silt[] Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ 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,) PACKAGE TREATMENT SEPTIC TANK( Size------------................... ................ Liquid Depth ..........................� Capacity -----------•-----•-- Type .................... Material--- ••••-- ------ No. Compartments ...................... Distance to nearest: Well .._Foundation ................ Prop. Line ...................... J LEACHING LINENo...of Lines ........................ Length of each line.___._....--•- -•.... Total Length ............................ N � 1 , 'D' Box ------------ Type Filter-Material ....................Depth Filter Material .---------............•...•:. ...:......_.-•- Distance to nearest: Well ........................ Foundation ........................ Property Line ..............__.........Z SEEPAGE PIT [ ] Depth .................... Diameter ................ Number .--__.......___............. Rock Filled Yes LE] No �❑ Water Table Depth ....................... .....................Rock Size ........................ ... Distance to nearest.• Well ..Foundation .••.... Prop. Line ............. REPAIR/ADDITION(Prev. Sonitati6n'Permit ............................................ Date ...................................I Septic Tank (Specify Requirements) -------- -•---•-- .--..... _ ....... Disposal Field {5 eci Requirements _ �- - --- •- --• .... )........................ .. ....-. T - r.. q �� l �---- --- --- - --------------------------------------------- -------------- ...................... ----------------------------------- ...... ----------------.----------- ._..........------------- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and .Heat 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. Horne owner or lieen- 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 W become subject to Workman's Compensation laws of California." --•-- Owner Signed ._..-...... B ........ ..............................��{Y_._...... . S tie .�� .. ...... y i (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... -------------------------------------------- .......... DATE .. 7S� BUILDING PERMIT ISSUED ...... DATE ......................• -- -........................... ADDITIONAL COMMENTS ......._ Y /7cr �..c�1Jk. ...._._.._ .......... r ........................................ ............................................ ...... ......................I....... ............- ....... .................. -... .............................•�..e..�..........................._.._..._........... :.. ....---•-• ....................I—-------------- ..__._.. ......--• .............. Final Inspection by: ...............W........I..... --...--- Date _....r� __ ... `s I JOAQUIN LOCAL' HI~ALTH DISTRICT SAN ... _ .....�. - E 13 241-'68 Rev. 5M 7/72 3 M