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► FOR OFFICE USE: y - APPLICATION FOR SANITATION PERMIT tComplete in Triplicate! Permit No. 7....�.....� ... .... ..................................................... This Permit fxpiros t Year From Date issued 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: JOB ADDRESS/LOCATION ..-..... _� � -'�.......... ..... "....................CENSUS TRACT ................ . Owner's Name ......."ce—t..G G- S014 ti 14C� .....................................................Phone Address ...........---------- city ................... Contractor's Name ----S/`}^^. ...... /Z .............................•--•-•.License # ........................ Phone ............................... Installation will serve: Residence WApartment House Commercial OTraller Court Motel [I 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❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam ❑ Hardpan❑ Adobe 0 FIII'Material ............ If yes,type............... ............ (Pot 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 240 feet,) PACKAGE TREATMENT j ] SEPTIC TAMC{ ] Size.... �^/ r ............... Liquid Depth .......................... T/wf' Capacity --------- ---------- Type --------•-•--------- material...................... No. Compartments Ga�✓G�2�%7.— Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LiNE j j No. of Lines-�J4T�Nength of each line............................ Total Length ............................ Box ---.--:..... Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ......--•-.........•••..........................Rock Size ................................ Distance to nearest: Well .........._.............................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................} Septic Tank (Specify Requirements) ........................................•-.._......_. .. . .......----._... ............................... .................. Dia � r&C /`®l'► 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:Distrid. 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 become su (ect t0.W +i+ Co nsation laws of California." Signed " -- --... - Owner By -------------------------------- • •----------- ----------------------------------- Title -------------------- .............. (If other than owner) 'AOR DEPART NT USE ONLY _ APPLICATION ACCEPTED BY . - -- •- --- DATE BUILDINGPERMIT ISSUED ..............------------ •------_... ----.•-...---------- .---------------.. ----DATE -- .._..--•--•-----•........ ----------- ADDiTIONAL COMMENTS ................................ _.. - --------------- --........................ ........ ................... . ...............-.........._............................. ...................... ............. -------------- Finalinspection by: -•---- ----- -- -- ---- -- -.... ....._....-.--..---•------..... .................-----•- Date .._ I .-. _............. EH 13 2h 1-68 Rev. 5 SAN JOAQUIN L AL HEALTH DISTRICT 8/711 3M