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FOR OFFICE USE: 3------- APPLICATION FOR SANITA°,iON PERMIT (Complete in Triplicate) Permit......... ...41. .......... This Permit Expires 1 Year From Date Issued Date Issued �6.-3' 73 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 I D SeLOCATION Owner'sNam . ._.� ..................CENSUS TRACT ....................... --... . �'��-••-Vii.-.... .• _ ........................•-•--••-- Phone Address .---. -••-•--. Contractor's Name . ;�,�J� � .-- #.�.��y��' --•--------• � .... . ..............License❑ P Installation will serve: Residence Apartment House 0 CommercialXraller Cbwpp• 5 . . Motel []Other Number of living units:...- Number of bedrooms ... ._.._-. ' Garbage Grinder . il' .. Lot Size .�,t''�,� ��---------------- Water Supply: Public System and name ...........................•_-______--___ _ _____ _ _ _ ____ Character of soil to a depth of 3 feet: Sand 05ilt Cla � � - •.Private � --••-•.... ...........•-•••-........ . ❑ Y ❑ Peat 05andy Loam ❑ Clay loam,® Hardpan❑ Adobe❑ Fill Material ------------ If yes, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be laced on r NEW INSTALLATION: P averse side.} (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-------------- .......... ._... •••• Liquid Depth .....--•-- Ca act ...---•--....--.r- p Capacity ---.._ Type .................... Material----••................ No. Compartments i Distance to nearest: Well ........ . . . . •-•-•••...............� LEACHING LINE .•..................Foundation ...................... Prop. line ...•--••- ............`� [ ] No. of Lines -----..........•.._._- Length of each line.__......_._. .•- , I" •-.-•-•-- Total Length ..........., 'D' Box .........._ .............•-•S Type Filter Material ....................Depth Filter Material . . . Distance to nearest: Well ................. -•••_......... ......_....._........ Foundation ........................ Property line SEEPAGE PIT ••••_____•__-•-••-_..•-� [ ) Depth -- •- ........ Diameter Diameter .-----••-•--.... Number ........................................•..•... Rock Filled Yes [3 No Cl' Water Table Depth ----•-••--- ................................Rock Size ...................... Distance to nearest: Well ...............•••_-_•__._• Foundation .................... Prop. Line �__ .... ---• ......._........•.....pREPAIR/ADDITION(Prev. Sanitation Permit # .... _ ate 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 Locol Health District. Homo owner or 1 ten. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed 011 --- .. . Owner ............................ (If oth an owner) - - --------- ........••-------•. Title - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �!��- BUILDING PERMIT ISSUED ........... .. .. .. .... ... ------------------------------------------------ DATE .J f l?• ADDITIONAL COMMENTS ................................................... .......................................................DATE ......_.._. Final Inspection by: 42- __._._.. _..... •. ._ .Date ...........•�•�•-�•- SAN -JOAQIJlt LOCAL HEALTH DISTRICT ` r E. H.13 241.'68 Rev. 5M