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"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7 �6 5. (Complete in Triplicate) .............. ............................ This Permit Expires 1 Year From Date Issued-a Date Issued ..�:. .. ../ Application is hereby made to the;San Joaquin Local Health District for a permit to construct and install the work herein r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ION ..r�-Ju„ .. ........... ..CENSUS TRACT ........._............. Owner's Name .1 Phone .................................... : ty.............. .Addres ..................... C ........... ...................................... Contractor's Name ... ...... ...: .. :.License # ../91,39>0'Phone .......................::..... Installation will serve: Residence ❑Apartment House C❑ Commercial [DTraller Court ❑ Motel ❑Other _-._ .�Garboge Number of living units ............ Number of bedrooms .......... nder ..............LotSize ...........................:......... :...... Water Supply: Public System and name ..:.............................................................................. ..... .......Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Ciay'❑ ' Peat❑ Sandy Loam Gay Loam ❑ Hardpan E] Adobe [] Fill Material ............ If yes,type ............................ i (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc. must be placed on reverse side.I NEW INSTALLATION: (No septicitonk or seepage pit permitted if public sewer is avoilobte within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size....................................: ........... Liquid Depth _... ....................... Capacity .:.................. Type --- _---.-.. Material---••--- ._... No. Compartments .....................� Distance to nearest: Well` ___.Foundation ..._�-_______ ______ Prop. line ( ] .. g . Total length . LEACHING LINE No. of Lines .-•-•-•.... ......:... Length of each line.___-- -._.......:......- .................... + t Bog ........ Type Filter Material ...Depth Filter Material Distance to nearest- Well ........_.................. Foundation .........:.............. Property Line ..................... SEEPAGE PIT j Depth .............. Diameter ................. Number ............................ Rock Filled Yes ❑ No ox Water Table Depth -------------•..................•Rock Size '1 D s.tonce W nearest: Well.........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. t Septic Tank (Specify Requirements) -------•.......:.................................... - ....._.................. Disposal Field {Specify Requirements) .-,�!_..., ... -r._ ..,. ----- ------ --- r...... ` ............. ts. t- I. -�- . . *.... ............. .................... ..... ............. ,........................ V 1 (Draw existing and required addition on reverse side) 1 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: E:. "I certify that in the performance of the work for which this permit is issued, II shall not employ any person in such manner as to become subject to Workma 's Compensation laws of Cali#ornia." Signed ........ ------. . - ---- --------------•-- Owner By ................. ..... Title ._._.._........................_.................................... . I (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........i -..: ....... DATE ... ._ i BUILDING PERMIT ISSUED -----------------=- .. ................................................:.....::.................•-----�-------DATE ............. ADDITIONAL COMMENTS i ---------•-------.•................................. I ............................................I.................................................................... ---------_-- _............. ....................................................] • ---••---------•-----......_....-------------------------------• ........_.................._..._._......... ............... DateI Final Inspection by: •:.................••-........................................... .........:........... -. SAN JOAQUIN LOCAL' HEALTH DISTRICT, E. H.1.3 241.'68-Rev. 5M 7/72 3 M