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FOR OFFICE USE: ............. .............................. APPLICATION FOR SANITATION PERMIT ;Complete in Triplicate) Permit No. ...7 .................... This Permit Expires t Year From Data Issued 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS LOCATI O / .....-��..L._...�.1?..... ....... . . .. :............. ..............................._-CENSUS TRACT Owner's Name ..........V? _ ....Pho .... fin. ...... .. ne�6r'.. 4 Address ................ ......_.... City ._. ............ ......... .. .. . Contractor's Name ...... --..License #r��—.��. Phone ..t �=7...... uJ Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court 0 14 Motel ❑Other Number of living units:...._'_... Number of bedrooms .....Garbage Grinder ....... Lot Size .�....•.......... SJ ......... Water Supply: Public System and name .......................... .......Private O\ .. Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay 0 Peat❑ Sandy Loam t9 Clay Loam .[\ Hardpan ❑ AdobeC:] Fill Material ............ If yes,typ ......... ........... V (Plot pian, showing size of lot, location ofsystem 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........ �K.�S,�'... ----------------- Liquid Depth ...�.�.f_..��.---___-- Capacity ....... Type _ . .... ..:..: Materialti:... No. Campartments � Distance to nares#e Well ..Q ...............Foundation ...Z_0.... Prop. Line LEACHING LINE [ No. of Lines _.._... :......:.... length of each line:.. . _..._..._... Total Length ...62_ 'D' Box ...._. Type Filter Material _112 ............... f ........Depth Filter Material ....... .................................... Distance to nearest: Well .....r Q.... .. Foundation. ...... ... Property Line ...---- SEEPAGE PIT Depth I [ 1 p ......... Diameter _ Number .::......................._. Rock Filled Yes Q No Water Table Depth .................Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........................ , .... Date .___.__. ......................... Septic Tank (Specify Requirements) ...................................• --------............•....---•--..............-------.........-•-........,. ... Disposal Field (Specify Requirements) .................................................... ................................. ................................... _ .........._.........._..........._.... _.-................_....................._._.........__........._.............................. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done lin 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 Workman's Compensation laws of California." Signed ...... _. ..... Owner By .._................ `"`--� ..- . Title r (if oth han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......................01F ................._--.-._...-----.............. --..................... DATE ..... ............ BUILDING-PERMIT ISSUED ..._............ ........... ..........._...............................................................DATE ....................... ...... ADDITIONAL COMMENTS ............ ..........I..................._... ....... Z", ••• . ............. . .. ............................... Final Ins ection bf Inspection Y .......Date X �r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'b8 Rev. 5M 7/723m