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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT �!7 y' ,,,1.. Permit No. .:7�-// ..... (Complete in Triplicate) Date issued ../...........:..... This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: � JOB ADDRESS/LOCATI,C)N ��"= -,� _ �- ..CENSUS TRACT ......... ................ �-7�7 -- - �-?�. - -. �_... - . .._ ... .. . . -. Owner's Name ............ ...11t? .7 �/.5------ --- -------...._...._.......... .. ------....._.. Phone ....... ...................... . .-cam Address _ S �i5/.}Snr ...... Cit . . ... ........ . ............... ................. Contractor's Nam1Y.4 -- - �cLicense # _ Phone .............................. Installation will serve: Residence �partment House❑ Commercial ❑Trailer Court 0 / Motel ❑Other _. ..: _._. .--------•- Number of living units: !- . Number of bedrooms .3 ...._Garbage Grinder lot Size - - -------.---------------- Water ..............Water Supply, Public System and name ._ ..---------................ . ......... --. ..... ................ ---...__...........Private V Character of soil to a depth of 3 feet: Sand jB_--'S_iIt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay loom ❑ *(� Hardpan ❑ Adobe ❑ Fill Material ..-. . If yes,type V) (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 seeps pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK j� Size-.....- ..---- .........o�_ , . Liquid Depth ....... ........ ....... Capacity/A� '0� Typ 4 .._ Moteriol4P' - N . Compartments ...........-.--- Distance to nearest: Well lout f-_..-__ ......Foundati to . �4`�- -.-.--- Prop. Line ._. �"""•.- _ �� Total Length LEACHING LINE [�No. of Lines � - length of each line - S �/ _;4i. -•-�•�"�-�-- 'D' Box _ Type Filter Material- --Depth Filter Materia) .... `�....- .---..... -•- Distanc�nearest: Well ...1 `t..... _, Foundation Property line . 5 . ...... SEEPAGE PIT [ ] Depth _ Diameter . ............. Number _ Rock Filled Yes ❑ No 0 Water Table Depth .......................Rock Size :- •----- Distance to nearest: Well . .-.. .................Foundation Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ....... --- Date ------ - ....................._) Septic Tank (Specify Requirements) .........:......:..------._ -....__.._. ..... ..___ .......... Disposal Field (Specify Requirements) - --- ... ' - --------- ... .._...... _.-. . - _.._---- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and #hot the work will be done in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents sl re certifies the following: "I certif that in a performance of the work for which this permit is issued, I shall not employ any person in such manner as to b come bje to Work s Co ens on lows of California." Signed - Owner ash 4-t� _.. .. ... ..... .. ...... __40, .-:..- _ .. Title _. By . (If other than owner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE . � .- _. ........ .. BUILDING PERMIT ISSUED _DATE ...... ADDITIONAL COMMENTS ._- __-.- - - .. """"----- _: ............ .................. Final Inspection b _ ..- -- Date . / — � .. ...X...---- L SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/72 3 X