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FOR OFFICE USE: = APPLICATION FOR SANITATION PERMIT ................ ...•-•---...._.....-•--•--------...._.._ a. (Complete In Triplicate) Permit No. ...� .. ..........:................................... r d Doti Issued.. Thi:Permit Expires 1 Year From Date Issued Da .................... 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.- JOB egulations:JOB ADDRESS/LOCATION ._.._ �Q©.r... �. ,�.--- °. 2 ..............:...............CENSUS TRACT .......................... Owner's Name ....�`. ..., ] ay----C...:_.- _ ._�.ss.............................................:................ .K.... --... Phone .��,� - ,Jr '�� Address ......... _1X_ / ` ...,4.1/ ...................-----............. City ...../i�a_T�../...e. .a.,... .s7./Z. (........... Contractor's Name ......_ .. L ......................................................License # ........................ Phone .... Installation will serve: Residence[ Apartment House Commercial ❑'frailer Court 0 Motel ❑Other............... ............................ Number of living units-------�__.. Number of bedrooms ...._.._Garbage Grinder .....�_.... Lot Size ............................. Water Supply: Public System and name ........................................... ...... ......Private �— Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loarn o. Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ........_... 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 200 feet,( PACKAGE TREATMENT SEPTIC TANK f ] Size...../4':1f_.. .............. Liquid Depth q p - Capacity -----------------_ Type .................... Material........... •------•-• No. Compartments ......:..............J i Distance to nearest: Well Fj�/_ _11 Foundation ld .. Prop. Line .. D .. ........... LEACHING LINE ( ] No. of Lines ----3--•.............. Length of each line----... _©..---......_.. Total Length ...._ 10..-•-_---..... x � epth .Filter Material -�'?� 1l r D Box ...../___ Type Filter Material ..�.`?- _.... ............................ Distance to nearest: Well -..--- ... Foundation ---...IA..f-•----•-- Property Llne ..-- J--I---•..-._. SEEPAGE PIT ( 1 Depth ..................... Diameter .�.............. Number .......................-_... Rock Filled Yes ❑ No ❑i Water Table Depth .......... _----------- •................Rock Size ............•-----....... ...... Distance to nearest: Well ........................................Foundation .................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit{# ---..--_---..._-•.......................... Date ---.--.._.... .................... Septic Tank (Specify Requirements) - ---••--------------------- ............................................................ r Disposal Field (Specify Requirementsl ............................... ----•-••-----••-•--•---------•--- -•---••-•------- ---------------------•---. :.....-- .....-.. --------------------------------------- ---- (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. Nome 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 became s t to Workman's Compensation laws of California." Signed _ . -- Owner BY --------------------------------------------- - .......`................ Title __---•-----------..._..----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __-- -. -• - ----• DATE ....._... ---------------- BUILDING PERMIT ISSUED -- ------ ------------- -----•---------,----------------•_...--_---------------------------------------DATE ................................... '... ADDITIONAL COMMENTS ------------------- -------- - ---------------------------••--------------_-------------- --- -•----•--.---...--------------.....- ............. •-- ------..._...-.--.-- .. ----••------. --- .....................•--------- --.._...----------..-.-------- -•--- ----- _--1-G..�� FinalInspection by: ..- •---•-• ............................... •----_---------•--------- --.Date -- _-• ---•......................... EH 13 24 1-6 ife SAN JOAQUIN. LOCAL HEALTH DISTRICT 8/74 3M I