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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ~ i (Complete in Triplicate) Permit No. ..75--/a 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: c JOB ADDRESS/LOCATION _cam-6F113 -l.9._ _ .- -S� CENSUS TRACT .. ........... Owner's Name ........Phone .. ��.- Address City ' C,- Contractor's Nome . r. �� v. - License # ,� . Phone Installation will serve: Residence 10 Apartments House,[] Commercial ❑Trailer Court 0 Motel []Other _ Number of living units: f Number of bedrooms .._.._Garbage Grinder - Lot Siz145� ._.r,/q- Water Supply: Public System and name _I__ . Private -- - ...... Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay E] Peat❑ Sandy Loam E] Clay Loom ❑ Hardpan ❑ 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 is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ l Size.... . _._.. Liquid Depth � __ Capacity Type __ Material_... _.. No. Compartments ...................... -Distance to nearest. Well Foundati Prop. tine _ LEACHING LINE [ ) No. of Lines ength of each line Total Length .- -._ V1 'D' Box Type Filter terial -__--- _-..._Depth Fil r Material Distance to nearest: Well _ Foundation Property line . .. SEEPAGE PIT [ ) Depth _ Diamete Number _.. Rock Filled Yes ❑ No ❑�' Water Table DepthRock Size .. _ Distance to nearest: Well . -------_....... ........Founda Prop. line .. . ................. REPAIR/ADDITI_ N(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 d6ne in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local. Health District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the perfo mance of the work for which this permit is issued, I shall not employ any person in such manner as to become ssuubbjecYtbrk 's C ensntion laws of California." Signed -7 ------------------_- Owner By _.- ...._ Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILpING PERMIT ISSUED - DATE 2 _- ADDITIONAL COMMENTS _ _DATE _ __ - - ------ - .. -. . . . .. Date .. —1-4)--'. .. - . . - - ---- _ _. _ __ . _ .... .. . . ..... .......... Final. lnsp - - _.. - - . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1.'68 Rev. 5M 7/72 3 M