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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT «...-._..-._..... ........... (Complete in Triplicate) Permit No. .1.....7• - ..• •- ........ 00 r•. ....................... „-„ ,......, This Permit Expires 1 Year From dote Issued Date Issued 1 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/LOCATI N 1./ -- G` .-. j ” •�'". " ��.d. CENSUS TRACT .......................... Owner's Name .... .... . 4. ...... :lrr._✓•........ . ,....._.... Phone ........................ Address .....`.. �1.. .. E`��: . _.� �._....: City .......... .... .............................................. ��---- ........license # .M&......... Phone Contractor's Name ....... - -r- E:........._3..... ............. Installation will serve: Residence❑Apartment House❑ Commercial [•]Trailer Court ❑ Motel ❑Other .... _••- Number of living units:.......--.. Number of bedrooms -..-.....Garbage Grinder ............ Lot Size ....-I"- ----------- Water Supply: Public System and name ....................•-•--------......---•-•••--•-•-•-•-----................_...............--•--•---•..........Private Cr- Character Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan e 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 isa available within 200 feet,) r PACKAGE TREATMENT [ ] SEPTIC TANK t Sizer/' .................. Liquid Depth ....................... Capacity ......... Type .... ...... No. Compartments ,-�................. Distance to nearest: Well ...................Foundation ...../_.0........_.. Prop. Line ....:5........ LEACHING LINE [I] No, of lines ... Length of each line.----.r+" ••• Total Length ...,l.zF?.6 .._. :a 'D' Box A...-... Type Filter Material ... S Z......Depth Filter Material ...../ 1.............r_._...-.._...._.. Distance to nearest: Well ......5Q __..... Foundation .........f '. ... Property Line ....'/` '.........,.J SEEPAGE PIT [1� Depth Diameter ... Number ..., ................. Rock Filled Yes QI"' No Water Table Depth ............. 4..............Rock Size ......1, ...x......•........ Distance to nearest: Well .........L -�p..:1,1::...........Foundation ...1,24-1.1 ..__ Prop. Line .....:5.''(�___...... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date .................................. ;+ SepticTank (Specify Requirements) ••..................-•-•••--•--....._..........---••-•---.............................---................._x.,........._..--••---........- DisposalField (Specify Requirements) .......................................................................................................•---................._.....•-- .......................................................................................................................................................................................................... ................. ......... .........................................................................._....._........................................_................................................... (Draw existing and required addition on reverse side) I hereby certify that I hp prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Statelaws, and Rules and Rvegulatians:of .he loci 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,J.'shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................•--•••-•-•--. SOwner ;. By .. .. ....................... .... t.. ................. . Sitle . .............................................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ........_ et..........................•--•-........---•• •--•----............................. DATE ...p'.. ` .. ................ BUILDING PERMIT ISSUED .. ..•- �y� TE . __... ' ADDITIONAL COMMENTS . ... .. t��' 1(/`��_G ............ . .. .............�/ t�2s� .................................................. ........_..................----..............................................................................•--•..................... .................................................`.........._................•-----..............._.........•----•..................................._.....__._..._..................._......._.._........ ............................................ .._.... Z .. ... .:: ..... .._-............ FinalInspection by: ........... .y:...............................................................................................Date ... .. ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/723 M�