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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .....-- ---...- ........................... \ Permit No. .��-�/�/ O (Complete in Triplicate) ..................................I..................... This Permit Expires 1 Year From Date Issued Date Issued ./.a.:...o:..73 Application is hereby mode 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/LOCATIO ....... `7.... t.. :a.. = c�-- ...............CENSUS TRACT Owner's Name 9...p........s.... . ... .......... ................. Phone _ Address ......-�...... ---.. f ! .? .. �.. ....... city .... .. ....... .................. y Contractor's Name .... �'':. ...... . :... `z-.. A- , License # .._1 .Sg..... Phone ................:...:......... Installation will serve: Residenc ❑Apartment HouseO Com 9rrc_ial_❑Trailer Court Q Motel ❑Other Number of living units:......I.... Number of bedrooms %'....Garbage Grinder ............ Lot Size -`.'�- ...77 . Water Supply: Public System and name ................. ......... Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ZClay 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 ;7ge pit permitted if/ public sewer is available within 200 feet,[ r PACKAGE TREATMENT [ SEPTIC TANK Size /a"Z.� .. .�. ...!S. :..... Liquid Depth . ..................115' C ! Capacity e Type . Material.. No. Compartments ... .......... Distance to nearest: Well .......... ...... ....Foundation ......... Prop. lie .... LEACHING LINE ( ] No. of lines ....c::,2........... Length a each line.._ ........ Tota) length 6.0 D' Box ............ Type Filter Material :.. :.:::Depth iter Material ...L.q:_: ... .................. iE Distance to nearest: Well ....... . ..: Foundation ...... 4 . ...... Property Line .....U�.. ... .... . SEEPAGE PIT [ ) Depth .................... Diameter .: :..:........ Number ..........:... . .... ..... ,Rock Filled Yes ❑ No Q Water Table. Depth .................................. .............Rock Size ................................ p Distance to nearest: Well ................................... . Foundation Prop. Line .......... REPAIR/ADDITION(Prev. Sanitation Permit# ... ............ ......... ... Date .) o Septic Tank (Specify Requirements) ...... Disposal Field (Specify Requirements) ... ......... ......... ........ ........ ............... ... .... .... ......... ......... ......... .................. •--........_...............__................------..................---......... .I................................................................... .... ......... .................... ...................................... (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 licon- sed agents signature certifies the following: "1 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 ................. ,... ... ` ! .. Title Owner .. . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ....... ......... DATE ? 7 BUILDING PERMIT ISSUED .................... .................... ..........DATE ... ADDITIONAL COMMENTS ... .. ....:......:..... ......... ..:.._ ......... . .. ......... ....................................................... .... Final inspection by +. ..... Date .�/��'.: l= SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3 M