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FOR OFFICE USE:...................... APPLICATION FOR SANITATION PERMIT Permit No. .�� .,u (Complete in Triplicate) ......._ �....... .................... ...-........... This Permit Expires 1 Year fret" Dote Issued Date Iaued .6. ........ 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 'S ..... :... . ..... ......................CENSUS TRACT ......... ................ Owner's Name ...W.t -.110al .. ............ ............ Phone AddressQ . 'J.... ........................................ City ... ..... ........... .,.................. Contractor's Name .� .. P ..�r ._ t?1..........................license 1M .1,J77: 1 ... Pitons • -- -r.r�'/:. of� Installation will serve: Residence*partment House❑ Commercial[]Trailer Court 0 Motel ❑Other............................................ Number of living units:..... Number of bedrooms .....I......Garbage Grinder �6...... Lot Size �x.� t Water Supply: Publ teas-and name ........................................................_................................. ..............Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam❑ Clay Loam ❑ Hardpan Q Adobe jg�- Fill Materlol ............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,) PACKAGE TREATMENT I ] SEPTIC TANK{ j Size................................................ Liquid Depth .......................... Capacity .................... Type ----------•--------- Material.............. ....... No. Compartments ......................� Distance to nearest: Well ....................................Foundation Prop. line LEACHING LINE [ j No. of Lines --------..............v Length of each line............................ Total length ........................... 'D' Box ......_ .... Type ;Filter Material ....................Depth Filter Material .... ..........................VN Distance to nearest. Well ........................ Foundation ........................ Property line ........................ SEEPAGE PIT [ I Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation ..........:......... Prop. Line REPAIR/ADDITION(Prov. Sanitation Permit# .................................•.--_....,_ Date ..................................I a Septic Tank (Specify Requirements) ------------------- -----•--------•---•••--.......--•---•--......... ........ ... ........... ......... ........ •••••--••............ ... Disposal Field (Specify Requirements) ._ r_... 1�...��. . ._f1 ..................................... '-----.•..........---------------------------------------------.......................................................................................................................................... (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. Memo owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed rQwner By i If other than owner! FOR DEPARTM T USE ONLY APPLICATION ACCEPTED BY = "'c-sf .-- ............. ------------ ------------- DATE ---?':t�.777....... --- BUILDING PERMIT ISSUED .................. .......DATE - ------ .-----. AD ITI AL OMMENTS ....................... ••-•-- ----..................•-....- . -------•------ ... .................................. .... ........... ..........-------...----....................•.......•.... -- . ......_•............... ........ ....._.............................---...... ......... .............. ......... ... ... ••..............._............ FinaHnspection by: .. . ...... .,:. _ .. ................................................:.................Date .. Eli 13 2h 1-68 N AQUIN LOCAL HEALTH DISTRICT 8/74 3M t