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/rvx err+ Mr: APPLICATION FOR SANITATION PERMIT C.... .....................1.0:.....----- Permit No. (Complete In Triplicate) . ..........�.............. '� Date'lssued .1d aj G ..... ...... ............................................ This Permit Expires t 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 described. This application Ismade In compliance with o my Ordinance No. 549 and existing Rules and Regulotlonst .JOB ADDRESSA N .4}}P.' ....... ----•- :.. ..............................CENSUS TRACT ...... ................... /....-Phone ..................... Owner's Name .. .�lA..4:e.---... ........ ........ . .,....... ............ ............... Address '- -! .� . ... .__........ City . . . ....._. ............................................... 0��z ... °7 Contractor's Name -------...License # /.1, .. Phone . ..: .�� - Installation will serve, Residence Apartment House 0 Commercial❑Trailer Court ❑ Motel ❑Other............................................ Number of living units.-../..___ Number of bedrooms „.....Garbage Grinder ............ Lot Size Z�.•el. ...................... Water Supply: Public System and name . ...................•--........—.......--------...._.......................................-•-.........Private Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam ❑ HardpanX Adobe❑ Fill Material ............if yes,type............... ............ fPtot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size................................................ Liquid Depth .........................6- Capacity .................... Type .................... Material...................... No. Compartments ....................X Distance to nearest: Well .Foundation Prop. Line LEACHING LINE [ ] No. of lines .--_-.----•-.-------_. Length of each line............................ Total Length ...........................Z 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................. . , Distance to nearests Well ........................ Foundation ........................ Property Line .......................� SEEPAGE PIT [ ] Depth .. Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth .............................................. Rock Size ................................412 n 9 Distance to nearests Well ----.•..................................Foundation .............._..... Prop. Line .................... REPAIR/ADDITION[Prov. Sanitation Permit 9)E ............................................ Date .................................. ) -p Septic Tank ISpecify Requirements) ...... ........................y�............ ..... .._............. . .� D;soosa! Field (Specify Requirement:) - --••••• . • .... -r •---•••- .............. .........------------------------------------------------------------.........................................................................I.................. (Draw existing and required addition on reverse side) 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 Son Joaquin Local Health District. Hone owner of lice"- sed agents signature certifies the followings "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 b o e ub' ct to rkma Compensation laws of California." :,-anec� . ... . . -- ----. . .C�-t�'- ... .............. .......................... Owner By �..(� �.� . r te........... ....... Title .... .......................... o er than owner} FOR DEPARTMENT USE ONLY . DATE ...f G APPLICATION ACCEPTED BY ...._. . .._ .. . ................. 7•�•.••.•••�'� BUILDINGPERMIT ISSUED ................. ................................................................DATE-............................ ADDITIONAL COMMENTS ...... ------------•-•--- .............. ........... ... .. ............... ------------•------- ............ ..................................... ----•............................. ............................... ... to ..... � �� ...---- .........I--- ------------------ Final Inspection by: _ .. ...............................Date ... ..� .. . �/ . EH 13 2]e 1-68 llov. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M