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FOR OFFICE Y, E. APPLICATION FOR SANITATION PERMIT ..... . ..........•----- l . h` .. 75-- .......... 7 (Complete in Triplicate) Permit Na. ..................... ..........,..:.............--••.......................•.._ 6-rF-�f` This Permit Expires t Year From Date Issued Date issued �................ 4 Application is hereby made to the San Joaquin Local Health District for a permit to constreid and install the work herein described. This application is made in compliance with County Ordinan Na. 49 and existing Rules and Regulations: ----.r •� . JOB A©DRESS/LOCATr .................................CENSUS TRACT .......................... Owner's Name 1 _.)-_ .Phone Address •....... ...................City ..............--••--................. . .... ... Contractor's Name 0_0 - �. . ..... ..........:..........License ..a/sJ` .1.. Phone Installation will serve: Residence artment Housefl Commercial CITrailer Court E] Motel ❑OtherOl ......,. . `............................... Number of living units:........ Number of bedrooms .............Garbage Grinder/ - lot Size ................ Water Supply: Public System and name ...................... ............................. .f/..............................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam S i Hardpan.[] Adobe !Materlal .............If yes,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 244 feet,)/` 'q PACKAGE TREATMENT j ] SEPTIC TANK ,j' .. Liquid Depth T _�-.. ....... . .................. 4�1 Capacity --- Type -- :. Material.... . x ...... No. Compartments t /. Distance to nearest: Well ... .......................Foundation ............. Prop. Line -..5........._.... . 9. LEACHING LINENo. of Lines ---- -- ----------- Length of each line_. .. Total Length 1.2A............... D' Box . .!a.. Type filter Material ! '!?._------..Depth Filter Material ...�c .................. i............................. - e� Distance o nearest: Well _.. -�_......_. Foundation ... Q..{..----.. Property Line .�................... SEEPAGE PIT � Depth --�.��. . .... Diameter ��_(�..__ Number ....��....................... Rock Filled No I[] Water Table Depth ..- ............. .. ......Rock Sizef }� Distance to nearest: Well ...../04......................... Foundation ......... Prop. Line .......... REPAIR/ADDITION(Prev. Sanitation Permit ...................................... Date .................... Septic Tank (Specify Requirements) ................. Disposat 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 HeaftW 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 --------------- ---- ----- BY ................ ................."��________________•--•----•- ......... Title ....... ......................... --------............................. r than owner} �. F9161DFOARTMENTUSE ONLY APPLICATION ACCEPTED BY ------------------- ---------------------------------------- DATE ./ ------- BUILDING PERMIT ISSUED ------------------- ._DATE ................................... ADDITIONAL COMMENTS ............................ .............. .....•-••-• - -------------- -----•--•----- _.c.. ..•'•• `- ` .... •-- � - _ . ... ..................---_--.-._....._...-- -- ------ ---------.---- ----- ----- •-------------------- J Final Inspection b ._..Date ....� ... EH 13 2h 1-68 lb,,v• 5m SAN JOAQUIN OCAL HEALTH DISTRICT 8/7h 3M