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FOR OFFICE USE: APPLICATION FO`i SANITATION PERMIT ......... ..............I. (Complete in Triplicate) Permit No. ..................... This Permit Expires it Year From Date Issued Date Issued .............:....� ...................................................... �F Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: CENSUS TRACT .. ........... i JOB ADDRESS/LOCATION ......._.�_ ._......... {� .0 G.. j-q- } Owner's Name .._-.--.�e.,w. .e..... ,.... �.1 !!/. a.c -,_... Phone 'Z- ........"..�.1._ Address ..... Sd"_7-!9�..................................................... .......... City ........-------............................................................. ---- Contractor's Name ..............5W f� ...................................................... --License # ......................... Phone ............................... Installation will serve: Residencepartment House] Commercial ❑Trailer Court Motel ❑ Other ............................................ Number of living units:...... Number of bedrooms ___.-��__Garbage Gri er .._.. ...... Lot Size ••...._____•...... ......................... ��tt rrYY Water Supply: Public System and name --------------- j--------_ . .. VC.1................................Private ❑ i Character of soil to a depth of 3 feet: Sand n . Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Clay Loam Hardpan C] 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,) t PACKAGE TREATMENT [ ] SEPTIC TANK( Size-------------- .........--........._...._... Liquid Depth ......-- •----•-•-• -• On Capacity .................... Type ........___...... Material-------__'........I.... No. Compartments Distance to nearest: Well ....................:...............Foundation ..._._ ............... Prop. Line ...................... V LEACHING LINE I j No. of Lines ------------------------ Length of each line............................ Total Length ..... (f E 'D' Box ------------ Type Filter Material ....................Depth Filter Material --------....................I.......... .__.. Distance to nearest: Well ........................ Foundation ........................ Property Line SEEPAGE PIT I ) Depth ..............._ ,Dlometer .- °.: :_...: Number .._......._....___...___.... Rock Filled Yes ❑ • No � Water Table Depth::-•--- -----•....... ••--.:...-- .. .Rock Size --------------•---•------------- Distance to nearest: Well .............. y Foundation .................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# _........................................... Date ....., .................... Septic Tank ISpecifY Requirements) ........ ...... . ..-_----------_- , s-Dispo of Fie! ISpec' y Requirements) 5-M l" - :. - P...............-......... r ....................................... .......................................................... ....................... ---------------------- .... (Draw existing and^regi►ired 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 Son Joaquin Local Health District. Home owner or Licata sed agents signature certifies the following: 1 "I certify that inthe performance of the work for mm_which this permit is issued; I shall not mploy any person In such manner l as to bec a subject to Workman" om sation laws of California." Signed . ..................... Owner By .----.... . Title - ' (If other than owner) en FOR JDEPARTMENT li E�ONLY APPLICATION ACCEPTED BY ,... ----••••• -----•. . ................................. DATE .... ... ? ------ BUILDING PERMIT ISSUED ....................... .. ................DATE ...................................... ADDITIONAL COMMENTS .--•-------------------------------•---------.--•.-••--------- ---- .....................................•-------..............:..-•............ ..............' -Final Inspection by- ---r- .......................................... ...........I........................Dot( SAN JOAQUIN LOCAL HEALTH DISTRICT - - - E. H.13 24 1.'68 Rev. SM _7/723414