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FOR OFFICE USE: �+ APPLICATION FOR SANITATION PERMIT ............. . . . Permit No. .....-. ..` (Complete in Triplicate) 7 �. .........•-•...... - '1 Date Issued .. �............. •-•-•-,._••-•.-•---•--_--- .......................... This Permit Expires 1 Year From Date Issupd 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 ...... .......... ......... ........ ............. ... .....Phone T f �, ......... Address ..................... ... +4................. .... City ....... Phone 1�.....� Contractor's Name ........... ... .�•-•----•-•-• ..._.........._......... License #a 3 `3 ....... _. .... Installation will serve: Resident4Apartment House❑ Commercial ❑Trailer Court 0 Motel,Q Other ............................................ '... / Number of living units:../-------- Number of`I 4ctrooms ....._......Garbage Grinder ............ Lot Size . Water Supply: Public System and name .......................,......................................................................................Privote)o Character of soil to a depth of 3 feet: Sand❑ Silt❑ "~Clay ❑ Peat❑ Sandy Loam 0 Clay Loam D Pill Jater'ral ............ If yes,type ........................... Hardpan 0 Adobe�&- (Plot plan, showing size of lot, location of system in relation to w ts, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Iigvbkkke within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANKSize.... ..1�c ..._...:... ..� -.- Liquid Depth .............. .. No.-Compartments �...... Capacity/AV _. .___ Type w._.. ll�ateriat... ....... Distance to nearest: Well t _t..........Founddfii n .... ...._. � :.......... Prop. Linq ............ i —2.. Length,of each (inel......�'- !r l....__.. Total. Ler+gth ..17.4?................ go LEACHING L1NIr No. of linea ....._. 'D' Box ...._ Type Filter Material ,/ .•.Depth Filter Material ......,1 drAi,............................. Distance to nearest: Well ....`.. Foundation ....../.Q............ Property Line ... ................ Z Diameter ... ..; .Number ...._.-�. ..._._. Rock Filled Yes; No Q SEEPAGE PIT ( t� Seth ��-•- ' Water Table Depth ......... ....... ... .. ............--_-. .Mock Size �a ��. l.r�1k........ Distance to nearest: Well .......LOU.....f...............Foundation ....d92._.:t".'. Prop. Line ..... ........... / REPAIR/ADDITION(Prev. Sanitation Permit# -z < SepticTank (Specify Requirem+encs) -- ...—Al......_ ...� : ::.:..:. ........... .......... .............................................................. Disposal Field (Specify Requirements) t ......................................... .............._. . ..._.....-_._._.. . ............................................. .............................................................. ---....--•................................. ..._--.---..._...-_........-•---•---..._._._.......__.._......_........__................--........._._.__...._..._.........-....._..__. (Draw existing and required addition on reverse s0e) I hereby certify that 1 have`'prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Stat* Laws', and Rules and Regulations of the San Joaquin Local Health 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." " Signed ......... . . .......- -t. . Owner C- !�••••+ BY ............. ..�` 4- •'-•' ...._. ... ._._...............----...._.. title ...- ' ....... (If oth han owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'"..- ,:.. . l . ....................•------.........._................... DATE ..d�_ZZ,r�?�Y............... BUILDING PERMIT ISSUED ....................... ..DATE ADDITIONALCOMMENTS ............................:....................................._._...._-...___.._....._....................._..................:........................... .............................................................................................................................-,.............................._...................._....................... Final Inspection-b' . ... .... ... .. �f'� .... ......._Date ..........-.:..1., ....� ...........- SAN JOAQUIN L L HEALTH DISTRICT r7! E. H.13 241.'68 Rev. 5M 7/72 3 M