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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a Permit No. .-7 =-••• .. " (Complete in Triplicate] Date issued ................................... ...... ..:�.'.---•••�7� This Permit Expires I 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 is made in compliance with County Ordinance No'.1.544 and existing Rules and Regulations: . ENSUS TRACT` ..• JOB ADDRESS/LOCAT O one . ......... Owner's Name ---- - - - ................................................. .. :...........� ... ._ ....._..... ..City ........................... ... Address � : ..License # �9��• Phone or ••=Residence . , Contractor's Name ._. - .-•" --- --. �� • - installationwill serve: ence Apartment House❑ Commerc_ _ ial ❑Trailer Court 0 Motel ❑Other .............-- - ,� ' .......5. Number of living units:.__..-_.._. Number of bedrooms ............Garbage Grinder ------------ tot ize Private ®---, Water Supply: Public System and name _.............. -•--•- Sandy Loam ❑ Clay Loam [� Character of soil to a depth of 3 feet: Sand❑ :Silt❑ Clay ❑ Peat❑ Hardpan E] y Adobe.❑ Fill Material ............ If es,type win size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.1 (Piot plan, showing NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available Liquid Deptht/�..................•••••- SEPTICTANK.f J Size................................................ ----•----......--•---•.._...-•--..... _...• . PACKAGE TREATMENT [ ] No. Compartments ..--..•..... ........ Material p X Capacity --------------.....-- Type --- -------- ,. Distance to nearest: Well ..__.._. • • _.�.......Foundation ....---...--•--••-- -" Prop. Line ---•-•-•..............� Total Length ......-•••••. O LEACHING LINE [ j No. of Lines --- Length a each line......................... . .De th Filter Material ...--.._...... ` fi 'D' Box ------ Type Filter Material .----•------•••- ' p Property Line ............. Distance to nearest: Well .._...----••_---••-• .. Foundation ...__-. .. Rock Filled Yes ❑ No ❑ .... Number ------------------ Depth Diameter ----....---• � SEEPAGE PIT [ ) p -----...Rock Size ---------_....---••--------•---- Water Table Depth +..................••....:•.__.. Distance to nearest: Well -------- ._Foundation ..._ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit . Date •------..---- REPAIR/ADDITION (Specify .............. ` Septic Tank (Sp fy Reuirementsl q ------------•-- ---- �. Disposal Field (Specify Requirementsl __ --------------------- ... ti. -- -"'- (Draw existing and required addition on reverse side) hat the work will be that I have prepared this application and tdoHealth District.in t h Son Joaquin I hereby certify uin Local HOMO owner of Iien County Ordinances, State Laws, and Rules and Regulations of the San Joaqe sed agents signature certifies the following: ermit is issued, I shall not employ any person in such manner "I certify that in the performance of the work for which this p r as to become subiect to Workman's Compensation laws of California." I ---• -......: Owner Signed •- - - •---•-.... --..... .......... ............ . litle . _.._ .............................. By (if other than ner' t FOR DEPARTMENT USE ONLY . DATE ....� a'#••-'�-`�................. l -•--------------•-..................... DATE APPLICATION ACCEPTED BY .. BUILDING PERMIT 15SllE:D . :.............................. ----.....--- ....................---- __._------...... ..................... -- - -- I ADDITIONAL COMMENTS .........................................•-•--•-•------- ••-----•--- •-............. _... 4 ......................................------... ..----...-- .-• •----•---•----•---•.......•-•:.............-•---- .•_..__..-----• --......... . . _ -• __ ...... ................ ... � to .. . Final Inspection by: _. • - SAN JOAQUIN LOCAL�. EALTH DTS7RICT-- a v 7/72 3 M