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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � ..................._..._._...------•--•- - �...-----•- ;Complete in Triplicate} Permit No. ................ This Permit Expires 1 Year From Date Issued Date Issued ..6.'.. ....... Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described, This application is made in compliance with County Ordinances No, 549 and existing Rules and Regu1 fons- JOB ADDRESS/LOCATION ,....��r�_......w_,...t. c �qG�[1-I.L4 ........CENSUS TRACT �` r........_: Owner's Name ..�fi .lJ��..-.. / 11 -----..................-•-•- ..............................................Phone•:�69: �2 d..V----- Address _..��.. _._._h.L�._....1eff.0.4•--Lt�R ti �'.L....f. .......................I City ------Lcwj-...................................................... Contractor's Name _..........................License # . ,Z .�..... Phone .. '3 3... Instollation will serve: Residence impartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ............................................. Number of living units__------- Number. of bedrooms ...r.....Garbage Grinder ............ Lot Size ......................._................... . Water Supply: Public System and name ........................................................__.....__........._.______.___._. --•----- ..........Private [C]/ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy loam El/Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location ofsystem 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; ] Size------------------------------------------------- Liquid Depth ................ Capacity -------------------- Type ------------- Material_--------. _ ...... No. Compartments ...................... Distance to nearest: Well ....................................Foundation -------- .... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ------------------------ Length of each line-----------------------..... Total Length .__......................... 'D' Box ............ Type Filter Material .........:.........Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation _..___ ----------------- Property Line .....................__- SEEPAGE PIT [ Depth Diameter ..............!. Number _.. .................... Rock Filled Yes ❑ No Water Table Depth .... ------------ ...............6..............Rock Size ..............................- Distance to nearest: Well ........................................Foundation ----- ..... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit+# ............................................ Date ......._.................`...----} Septic Tank (Specify Requirements) .........-•••••-----------•-----••---•-----••--•-•--•---------- ------------•--•--.1V!N...DAY"DAY"..._ Disposal Field (Specify Requirements) .._ Q�_-----_---y .______l1._ L '--- 4-,v 5,� -- �... / c r,��..._ /� ------ R .._ --- - -------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the wank 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- "[ 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 sub'ect to Workman's Compensation laws of California." Signed ........ .. .............. - - Owner' By .....-.... .. .Xc /-- ..............•----•----------------------------- .......... Yitle ---.-{/ (If other than owner) " FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... :.. ............................................... DATE ..!��_ 3 BUILDING PERMIT ISSUED ......... ---------------------------------------*.... .........••-• - -- ------------- --_..-...-- .................... ..................... DATE ..................................... ADDITIONALCOMMENTS ........................................................... ................................................ .......................................... .............. Final Inspection by: :... ©ate SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1-3 24 1.'68 Rev. 5M 7/72 3 M