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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................. ............... - 36 -•• ICennpietein Triplicotei Permit No. :7-.....1` °.�. . _ +� .. This Permit Expires 1 Year From Dote Issued �� 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 ......;?-_-5713.__._,�o(,!. ...CENSUS TRACT Owner's Name /vA / TR................//............................,............. ------.......Phone ......... .......................... Address _ .S'f.3_..... . , -/ � fnr�... K-- ...... <<cr�; ........ " p ................. city .... ...----.......................... ..-- Contractor's Name ------ e&..............License # Phone -. lk'.�`-.'•.�` Installation will serve: Residence KApartment House Commercial❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:.... Number of bedrooms . ''-:_Garbage Grinder .... ....... Lot Size ....� .. sc: ----------- Water Supply: Public System and name ............................. ..........Prlvate,! Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay Loam ❑ Hardpan 0 Adobepr Fit)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,j PACKAGE TREATMNP ENT ( ] SEPTIC TANK{_] Size......••... . Liquid Depth Capacity Type ---- Material........:............. No. Compartments Distance to nearest: Well ....................................Foundation ......... Prop. Lina LEACHING LINE ( ] No. of Lines ........................ Length of each line............................ Total length ............................ Z V Box ..__........ Type Filter Mowal ....................Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundation -•-•-------............. Property Line ........................� SEEPAGE PIT ( j Depth .......... ......... Diameter .................. Number ......_.. .. ........ Rock Filled --Yes [I No CTWater Table Depth ................................... ..•--••.....Rock Size ........................_....... Distance to nearest: Well ..................................... Foundation .................... Prop. Line ......................l�. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date .................................. Septic Tank (Specify Requirements) ...... ........................................................................... Disposal Field (Specify Requirements) ......5 .....7..4 _..._..... ............. � Sys -------------------------------------•---•-.---------------------------------------------------•--------------•------------•--------- ....................................... (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 Son Joaquin Local Healtit District. Henle owner or licew 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 becomub)ect t9 Workman's Compensation laws of California." Signed _ . .........................._. --• Owner ------------••----• Title other than owner) FO DEPARTMEN USE ONLY APPLICATION ACCEPTED BY ----- ... ---••-- ---•- •......................... . DATE BUILDING PERMIT ISSUED _.... •--------- --------- ................... --•-_.---------- ------------:.DATE -------................... .............. ADDITIONALCOMMENTS -------------------------------- -•----•---•-•-•---•----- _. ......... ----------- ........_-...-..--------------....._.._.: ........................ ................... -----------•----- ......... ........ ......... .................................I................... ....................... ------- --------------- Final Inspection by ----- ._ Da#e .f�--..� . .. ...._ Eli 13 24 1-613 Nev. 94 SAN JOAQUIN L L HEALTH DISTRICT 8/74 3M