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FOR OFFICE USE: 3 APPLICATION FOR SANITATION PERMIT 7S- Permit No. .............3 e � --.._.. (Complete in Triplicate) •••.. tt This Permit Expires 1 Year From Date Issued Date 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 jin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION S._.. ?tern-s........................... ............ ......................CENSUS TRACT ....................... Owner's Name ... John Travail.le ..Phone .........................................:................... .................................... Address ...............................................•----.....--•--........---...................._•----•... City --.......................................................................... Contractor's Name .......A�242..Rooter•- Sewer Ser. License #271539 Phone 1165-2616 .............••----•...........----.......... ---........----_. .._-....._-- ........................ Installation will serve: Residence$]Apartment House Commercial ❑Trailer Court 0 Motel ❑Other............................................ 5 5 Number of living units:.....I..... Number of bedrooms ....3......Garbage Grinders---__ e s...... Lot Size..__0 x 1 0 Calif. Water Ser. Water Supply: Public System and name ................. . ..••-----.......-------------•---•---........._..........._-•--.......... ............. Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ❑ Adobe ® 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT O SEPTIC TANK-[�' Size................._X... ................... Liquid Depth _....z......._...........J Capacity .._12-00..... Type W-e...cas.t Material No. Compartments 2........:.............% Distance to nearest-. Well ......... ...Foundation 10 ' ... Prop line .?' %P LEACHING LINE (x] No, of Lines 1...................... Length of each line.--60- .................. Total Length .. 01........._..._._._. 'D' Box .... es. Type Filter Materiak o ok........._..Depth Filter Material .....1.8!................................ N Distance to nearest: Well _.-_.n"a.... Foundation .10_'................ Property Line 1.. .................. SEEPAGE PIT [ Depth �... ................ Number ..._ ............. Diameter 4"21' 1 ...................... Rock Filled Yes [ No C] Water Table Depth .__ .68._..................................Rock.Size1 - Distance to nearest: Well ....... ........................Foundation ....... ........ Prop. Line -5.1................. REPAIR/ADDITION(Prev. Sanitation Permit# ._ ... _. Data .) Septic Tank (Specify Requirements) ...Add...ab-ov-e-••sys-tem....to exist; rig ee t3a eye•tem,........................... Disposal Field (Specify Requirements) ..............abandon•.old_..tanks.-...............,,,,........,......,.........,..,,,,,•,,...,,,,,- -----------------•---••-----.-----..-------•---------•---•--•-------------..._...------•--.......--•--------•-----•--............--.....------............................ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be don* in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local Health District.Horn* owner or licen 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 become su ct to Workman's Compensation laws of California." Signed .............. . :.: .... .. .. ........_.... ••.....__..........._..._ Owner Contractor By __........... ---•-•-•- ........... Title ......................... ......•-•-•............................ If ther tha owner) , OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... -2; ".. ..._ • --- ....................•--.........DI.A...T. ATE ....5":..T....: ... ............. BUILDING PERMIT ISSUED .................. .. DATE ADDITIONAL COMMENTS .. .` .. ............................ --.. ... .............. ......... .... ........... ... ............................................................................................................. ............................... •_.. ....... ...:.... .. ..... .... .. .............................................. ....... ... + Final Inspection by:.. .. . ... . ... .....................................Date ... SAN JOAQUIN LOCAL HEA H DISTRICT j E. H.13 241-'68 Rev. 5M �(� 7/72 3 M