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S FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT .......... - ............... .... . (Complete in Triplicafe) Permit No. ..................... This Permit Expires 1 Year From Dote Issued DateIssued .................... Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliannc`e' with Count Ordinance No. 540 and existing Rules and Regulations: �6 r ` � f... .-..-CENSUS TRACT .......................... JOB ADDRESS/LOCATION .__... � __ .__ _. -_ -_. ..-----.- .. �.. . Q� r Owner's Name ......... ...Phone .................................... Address _ . . - .. ..... _.. ...... City ........................................ Contractor's Name . jA-- ...License # Phone,0,.72a4741 Installation will serve: Residence kApartment House❑ Commercial (]Trailer Court 0 Motel ❑Other _.._. . - - _------- -------------- Number of living units: . /. . Number of bedrooms ..........Garbage Grinder . lot Size _.4—.0 .•-••- ......... Water Supply: Public System and name - ..10. , < ........... .....__ Private' Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom Hardpan Ado�❑a Fill Material If yes,type - -.. -- (Plot plan, showing size of lot, location_`_b-f-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 [ ] SEPTIC TANK' Size..C. --- -- -- Liquid Depth . ................. Capacityl.16VC4,Z Typeoterial._ . NO. Compartments ..-.2—............ Distance to nearest: Well ! Foundation ndatiQn / .. ... ... Prop. Line ..%17. . ......f .. LEACHING LINE ' No. of Lines Length of each line total Length .... 'D' Box J Type Filter Material A40e......Depth, Filter Material ................................•- Distance to nearest: Well . .Q' ..__. ._._._. Foundation Pro Line SEEPAGE PIT Depth `.._ ._ DiameterNumber _... ,, ...�. Rock Filled Yes No rD Water Table Depth ..::.....................Rock Size --. ..................... ell Distance to nearest: Well .. '. .....................Foundation ---1� ...... Prop. line ---L�................ REPAIR/ADDITION(Prev. Sanitation Permit# ........ _. ....-- ------........-...-- Date ..................................I Septic Tank (Specify Requirements) . . . ... ....... - - ------- ----- --------_..__.- ...... -------- ...... ................................ Disposal Field (Specify Requirements) ... ------- -----------._......... --------- - :.: _._... .... . ..... . .................... ........ .. ---- - _.. ._ -----------......... --------- ----- (Dra'w existing and required addition on reverse side) 1 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 Jooquin'Lecel Huth District. Home owner or licow sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall nN employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _.. _.. __.. ... .. .. ............... ....................... Owner By , _ .... Title '1 ............. ... (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ _ DATE ._ ,_740/ r......... BUILDING PERMIT ISSUED .. ..DATE ......... ......... ...... ADDITIONAL COMMENTS ........ ........... - . .._......... ---- --- ----- --- ... ... . ... ... . _ . . . .. -------_ ................... Final ------ FinalInspection by: .......,........... -------- -------- - - ---------------- -------- --- --------------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 247/721-'68 Rev. SM -_3 "I