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FOR OFFICE USE: APPLICATIOWFOR-SANITATION PERMIT Permit No. ...��-3` �. {Complete in triplicate} ............ .......... Date issued . .:1 :.'?..... ... ......................................... ....... 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. 549 and existing Rules and Regulations: l ...CENSUS TRACT .......: ...:.:......... JOB ADDRESS/LOCATPN ,. St . -. .-•... .......... Q Owner's Name ........ ... . ...... .... .'�. ...... Phone � ..... ... ............... / - ...7 _..... Address / �,et.,r... pity � Phone .,.. ti ......-.....-.License # ... Contractor's Name ..........1........ ...... ........ ...... Installation will serve: Residerict;lo�Apartment House Commercial ❑Trailer Court ❑ Motel ❑Other ..........................:._ r '. :- . Lot Size .... Number of living units:-----i..__...Number-iof`hedrooms _... .Garba`ge Grinder . private Water Supply: Public System and nam ._::3 :.......................... •-------- ••. .............. ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt C3My ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ AdobeV, Fill Material :�..._._.... If yes,type ............................ (Plot plan, showing size of lot, location ofsystem in relation* to'wells,-biuildings, etc, must be placed on. reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic sewer is available within 204 feet,I ,� l Size...��.. :-- ' Liquid Depth ... ............. PACKAGE TREATMENT [ � SEPTIC TANK ---•--••••`- •' 2�• � _ _g_, • .. No. Compartments Capacity Type -�c�l....:_. Material. fF'��'... p ............. , p Y a� ' "'�.... Distance to nearest- Wel{ ......................Foundation ..._/...Q_...s__...... prop. Line � �. LEACHING LINE No. of Lines ------_ Length of each line----40.x•--:.......__• Total Length -./........................ -n D' Box ..__......__ Type Filter Material .. Depth Filter MaterialC --�•--..----.•--•••-•-• _..... i Distance to nearest: Well ......... . Foundation Q... ------ ... property line -5.................• SEEPAGE PIT ( Depth ._Z.--�- Diameter plumber ..._....__�................ Rock Filled Yes No C3 Water Table Depth Rock Size I� __......... _}...... r y Foundation ...f Q (# --- Prop. Line ... Distance to nearest: Well - •' ' • - REPAIR/ADDITION(Prev. Sanitation Permit# . Date .....................-------------) Septic Tank {Specify Requirements) ......................•------ -----••--..._.....----..__.....-------........------._....------ ----- .... 1 ............................................ 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-net employ any person in such manner as to become subject to Workman's Compensation laws of California." ISigned .................... ......-..... .................................. Owner By .-------- ._..... - .......... - . Title ...... .. ._............................................. ..... k (If oth an owner) I TMENT USE ONLY APPLICATION ACCEPTED BY ....... -•-•-•-------------............I................. DATE :..:.:. �, �•• -7......... 4 BUILDING PERMIT ISSUED ......... ... .. . . ...• . •. - . ' .`- ..........•-t_ ........-.........__..... .................----..............._._... ' r----_. :Y........... .................................. D TIO AL COMM T tv .. .. to ._ Final Inspection by: ................................ f I S� , / l. JOAQUIN_LOCAL HEALTH DISTRICT L/ 7/72 3 M . 11 24 � ice o iCAA _