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FOR OFFI E USE: AMICATION FOR SANITATION PERMIT ..................r" Permit No. � .... ........... (ComphNe in Triplicate) ................. -I'�.��......... Date Issued .................. ......................................................... This Permit Expires 1 Year From Date Issaed 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�nty Ordi once �49 and existing Rules and Regulations= 7 cy/ JOB ADDRESS/LOCATION 1��/ . ....�/..- .-----. •-•............ .. . ...........................CENSUS TRACT .......................... �} _ _ Owner's Name ................. f2 .cam= � ....... ....... .....al�.. .................Phone Address ........................ .,� . /../........ ..............City ............................................... ............................. .. .... Contractor's Name ----- .r �f 7• " =� d D ry�.. ----....License# ........................ Phone . 1 Installation will serve: Residence Apartment House{] Commercial[]Trailer Court E] Motel❑Other............................................ Number of living units:......... Number of bedrooms .,-.3---Garbage Grinder ............ Lot Size ... ...-.: ........... ........ Water Supply: Public System and name .................................................................._..........................................Private Character of soil to a depth of 3 feet: Sand n Silt Q Clay Q Peat❑ Sandy Loam❑ Clay Loan Hardpan 0 Adobe f@� 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 INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! PACKAGE TREATMENT [ ) SEPTIC TANK j ] Size................................................ Liquid Depth .......................... Capacity ......... .......... Type -------------------- material...................... No. Compartments ...................... s Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... l g ..... Total Length J LEACHING LINE No. of Lines _.._-•-.-.--.--•--.--_-- Length of each line...............•.------ •--•--.................._... 'D' Box Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT ( ] Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth .........---•...................................Rock Size ................................ / Distance to nearest: Well ........................................Foundation .................... Prop. Line .....................00 REPAIR/ADDITION(Prev. Sanitation Permit .�. ................ Date .................................. . Septic Tank (Specify Requirements) •..:..._. : ._.... e�— Disposal Field (Specify R quit ants) s <: ]Xz , .....---• j Q- - .. ................................................................................. l.. _..... .._.''... - c�-------------_ - - .... ...- ................•----. .........----........ (Draw existing and r uired ition 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 licen- sed agents signature certifies the following: "I certify that in the perfo ce of the work for which this permit Is issued, I shalt not employ any person in such manner as to beconTR subie n's Compensatio aws ofCalifornia." �1 cCTI Signed .....41). .. _5...._.._..1..------. '` �� ----------------------`' -Owner By ---- •------------------------------------------------- _ (If other than owner) / FOR DEPARTMENT USE ONLY z ` APPLICATION ACCEPTED BY . . -----. DATE �.� ---------- BUILDING PERMIT ISSUED _.. ................ ..................................- ..._.-.DATE ------ _ ------•---.... --...---.... ADDITIONAL COMMENTS ------. . Q Com... .... ................•---........._..-._.. - ------------ ------------------------------------- ----------------- ------ ............-------I.................----.......... ---------- -----•-----......_.... .......... -------------------------- --- _ ... . _ __... -- ----------...._ -....--............----.- - ..- - . ......... Final Inspection by: ------ ....--................... ........... ........... Date .. . lrj� EH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M I