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FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT L .-•.•-- -_- [Complete in Triplicate) Permit No. -:7.`.`.......... This Permit Expires i Year From Date Issued Date Issued .j............... ' 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 isting Rules and Regulations: JOB ADDRESS/LOCATION . .. ............ .... v.... r ...�.. ..._.- 'i .....CENSUS TRACT ...........__............_ Owner's Name ........ --- .........Phone ..�. .�. �$. . Address .. ........:......f�� -c�' .. - '! �- . _.... city . ... Contractor's Nome , --•--.. .. -. =.--- .License # � . `Q f Installation will serve: Residence ❑ Apartment House fD Commercial Trailer Court ❑ Motel ❑Othe Number of living units:............ Number of bedrooms -----------.Garbagerrinder ............ Lot Size .._........-- � Water Supply: Public�'k'. . . ....:....:... 5ystem.and name ____ ____ ___ __ Private ❑ Character of soil to a depth:of 3 feet: Sand Silt Clay L - = :: C7 .-❑� y ❑ Peat❑ Sandy loam ❑ Clay Loam [] 1 f - ardan Adobe Fill Material _.... If es, e �p_.� Y type (Plot plan, showing\size of lot, location of system 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 �. �_�. Type Size_ .. ..k.: ......-_.. :_.. Liquid Depth ................... N I Capacity .- -- YP� Material............. No. Compartments 6 ..............•---- Dista ce. to. nearest: Well - _� . ... ....... .... . .....Foundation ................... Prop. Line .____..........._.. LEACHING`*FV LIN00 E• [ ] No ,of.'-Lines Length of`each line.... -...: ..I.............. Total Length t ~ --; g .....-----•---_-----..._._. I l . � D Box Type,F,ilter Material -4 0, ---------------- -Depth,Filter Material ...- -........ r ------------- Foun . Distance to nearest: Well _ ation ....�................. Property Line -.-•.-_-•-•- SI:EP�AGE PIT j )4 ��Depth � -�• •�-- Diameter �---••----- Num f�� ----...__:.. ber . ........... .. Rock Filled Yes ❑ No {] Water."ttitl e Depth t ' =-- -.Rock Size - -..- ��, Distance-to near`est:Vwefl'.-:-- :'i`-�`(----•--.-- 't� Foundation _.•........... ..... Prop. Line .._...._....._ ....... C) REPAIR/ADDITION(Prev. Sanitation Permitl# .._--_ 1 � P i � .. ._.....� �- ---- ------------- Date _..---�-•---.. _ . . ) 3 Septic Tank (Specify Requirements} -._ _... i Disposal Field (Specify Requirements) .--_-_--.. --- ----------------------- - 3�<--- -.-•-----. ---. ��,... (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 [icen- sed agents signature certifies the following: "I certify that in the performonte 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 .... r (I oth t an owner .................... Title . .._. FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED-BY ."--•.- ' .. - - - - --- �.... —. .A ..,�?_ . _.. ------BUILDING PERMIT ISSUED --.-- .e...r.. _ ... y..- --��- ..._ ......_` ,'.,.".`DATE -- ADDiTIONA! COMMENTS 4 .._ ...._.. ----- _ ...........-. ,;. � .................................................. _.... ........................ ......... ..... ......_.._.. .......................... _._.___....__.-- -..._.__....-... _...._....._.........I-----....__..--- ...........Inspection by' . r +�%t ------ -------`..__...----••---•-•-------------•--....---•-•--- ----- -._....-.--_....��..,. � .-.-...-----. Final Ins ection b i Date ?..-. 5 ....--••--- SAN JOAQUIN LOCAL,HEALTH DISTRICT E. H. 7 3...24 1 '68 Rev. 5M '