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rum OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. .... S - �--- -------------"----- r .............. 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 in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCA I N CENSUS TRACT Owner's Name ,--. - .....Phone . Address k .� _ /'f�` �' Ci ....... ... Contractor's Name ................. 'cense # Pp . � Phone Installation will serve: Residence Q Apartment House Q Commercial ❑Traller Court )❑ Motel ❑Other ..... Number of living units:.. . ------ Number of bedrooms _3. Garbage Grinde ....��........ . �"' Water Supply: Public System and name __________________ ___ r ...........- Lot Size ................ _..........-.............•--. .......................................................Private ❑ Character of soil to a depth of 3 feet: Sand M Silt❑ Clay 0 Peat❑ Sandy Loam 0 Clay loam ❑ Hardpan ❑ Adobe❑ FIN M1 6terial ......_...-- 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 [ ] SEPTIC TANKI, �® l Size_.... ....... .... Liquid Depth .......................... Capacity // .-� P tY ---A_�C'.------ Type ��` . Material........-............. No. Compartments ....Z............. Distance to nearest: Well ............... .Foundation ............. Prop. Line ...................... LEACHING LINE [ } No. of Lines . ..._. _._.. Length of each tine--------7 ........ ...._ Total Length ...._�..1..:.t.�1..`�.. 'D' Box ------ _.._ Type Filter Material ....................Depth Filter Material . . . _. . Distance to nearest: Well _.. .._..��...._ Foundation ... f......... .. Pro erty .Line . .. f Property ............. F SEEPAGE PIT [ ) Depth -------------------- Diameter ---------------- Number -- ... Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------- .....Rock Size ...... --•--- ---......-••------ Distance to nearest: Well ----------------------------------------FoundatiorlI .................... Prop. Line ...................... t REPAIR/ADDITION(Prev. Sanitation Permit# ..........-----------"...................... Date .......... } Septic Tank (Specify Requirements) .... Disposal Field (Specify Requirements) -----._.__._ --- ----------------- -- --- ------------- ---- ------------ .....-----••-• -- ----------- --------------------- ----------------- -----• ........................ ------------------------------- -... --------------- ----- -- __ _ _ ___ _ ___ (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. Home owner or licen- sed agents signature certifies the following: �--- "I certify that in the performance the k whicliw:this porinw.,is is ved, i shall not employ any person in such manner as to b e ct to W a ' $ ton laws of California." Signed _ ��r ---- ------------- ------- BY ' l. T�` � 1�'� �/� -----�----- -r... Title - -............ (If other than owner) FOR DEPARTMENT USE ONLY __ — PPUCATION ACCEPTED BY _Y�� DATE BUILDING PERMIT ISSUED - - ----DATE1" IDiTIONAL COMMENTS _-- _-_. -- � -"-----�--"' """""" ----------- ------ - ---- ---- -- -- -- ------ Final Inspection by --.-------- EH 13 2h 1-68 �---- ----- ------ -- Date • 511 - - --% .. . ---. . SAN JOAQUIN LOCAL HEALTH DISTRICT 87}1 3M