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" FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT7 y-�3 y _...-..._. Permit No. .....- (Complete in Triplitate) .... ......... ............... ..__......--- 7--751 ......................... ...... ....... This Permit Expires 1 Year From bate 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. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION 1-.13_` Q__... ._ .................. .............• ..---..CENSUS TRACT .......................... Owner's ... -`..../l�' .----- ......Phone ........... ---------- ............. Address Q ��d City .. . ....... . f e,� ...._. �7— Contractor's Name '...�.'� ``' - ......-----... . .......... ...License # .` ' ........-.. Phone -----------------------_-- Installation will serve: Residence �ortment House❑ Commercial ❑Trailer Court :❑ Motel ❑Other . . .. . ....................................... Number of living units: . 1 ... . Number of bedrooms ... Grinder .. ... ... Lot Size ..-.. ...__......_......................... Water Supply: Public System and name . . ................--------------...--------- ------------- .--------------•--• --_..--------•--..........Private Character of soil to a depth of 3 feet: Sand 0 ilt❑ Clay ❑ Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe ❑ Fill Material .... If yes,type ........... . ...- ... ... . (Plot plain, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)\A NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublicsewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK IV Sixe..4/ ... _ ----- -- ... ...._. . Liquid Depth ....�.................. E Capacity �.�-d� Type .... .... ......... Material.-r�+t' No. Compartments ............... f Distance to nearest. Well . ____._._.,-•-_.._Foundation'..../.0.--" -.-...- Prop. Line .. ............. LEACHING LINE V�l No. of Lines 3 Length of each line .,.,..��... . Total length ,_� e--.l........... 'D' Box .f Type Filter Material ...._ ._P�.....Depth Filter Material ....../9-..�~._...... . . ` Distance to nearest: Well ----..,.So:.......... Foundation x.11............. Property Line _.,.F__... ........... _ '. SEEPAGE PIT [y� Depth .5 _ Diameter __.._____ Number . .-.. .. Rock Filled Yes [ No ❑ Water Table Depth ........... ---------,------Rock Size Distance to nearest: Well ---------- ---•.....................Foundation .... Prop. Line ......�3.............. REPAIR/ADDITION(Prev. Sanitation Permit# -------- --------------- Date ------------.-----.-..---.--.-----} Septic Tank (Specify Requirements) ..-- r--- .......................--•---------------....... ......................................................-•........... Disposal Field (Specify Requirements) ................-------------------------........-- -- .............. ... . .- ........ -•---- .._._......... ............... ...... .......... ------------- ---- - --------.......-------- _ -- .. ..... .... ... . _ .._.... .....---......- (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: "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 Workma ' Compensation laws of California." Signed ... .... ........ .......--- . -•-- . .... Owner BY -._. --- .r... ... Title '. . .. .... .......... .. .- (If other than o er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY eW____.. - ----- ... ..... DATE . /..0 ._..7. ._._..... BUILDING PERMIT ISSUED et. -f DATE - ADDITIONAL COMMENTS .. .9 -1371 Ti �l.G - ............................................ ............................... .. .................................................. FinalInspection by: '--------- ----------------------------------- -----------------------------------------------Date . .. X 7y-....._.......... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H,13 241-'66 Rev. 5M - .7/7i �I