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FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT ........ .........�.. ..........-..... 7S_571 (Complete in Triplicate) Permit No. ........... ....•.... ---...=----- .. ......... . .... Date Issued r .� ... . . This Permit IExpi es 1 Year From bate Issued Application is hereby made to the San Joaquin Local Health District for a hermit to construct and install the work herein Ia described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ... ...... � ..- .................CENSUS TRACT ......................::.. € Owner's Nome__,. _. ... ,. ...... . ----.Phone Address .. - � ... .. ..-.-_. C:y .. rr11. Contractor's Name ._.. ...... ..... . ---: �... -----------_ License # 3.L•3.... Phone ��'--p�Q7..... Installation will serve _Residence„❑wAportmen use 0 Commercial ❑Trailer Court C]It Motel ❑Other . er of iv Supplly: Public Systema units: �",Number of bedrooms ............Garbage Grinder ..-..------L lot Size ......... .. Num . ....... Wateb .... nda m ......................... -.-::.._.._...;.....;.._.......-•---...........------ ...--------------.Private f Character of soil to a depth of 3 feet:t•- Sand Cl ,Silt❑ Clay ❑- - Peat❑ =Sandy Loam r]T Clay Loam` _iaardpan.E] Adobe j Fill Material .:.......... if yes, type ........... ......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mustbeplaced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic sewer is available within 200 feet,) 11( \j PACKAGE r PACKAGE TREATMENT SEPTIC TANK Size.... �?-. ..6------., ..... Liq iu d Depth .---.5��..- h Capacity oda® # T e Material . ?� p Y 1 r t YP_. •-r ..... No.� Compartments ` Distance to nearest: If COt9 __ - Foundation .. Prop. Line .... r _._._.. { LEACHING LINE No. of Lines l --- length of eacb, line.......CO-� Total fength .. •............... . 'D' Box .-... iT �r yipe.Filter,Material .. .. ....---Depth° alter Materia) -.. Ick.-..-.--.-..•.._.......•-.... .. Foundation Distance�ta.ne�are�: Well �'��.-. --- l:Y)�f'��.��Property Line ��__......... - �11'x' SEEPAGE PIT [ ] Depth '$ .- D io”m tes"""t... ...... Number _ ..-.. .- Rock Filled Yes ❑ No ] Water Tale Depth .. .. .----- ._..Rock Size _.Jfr;€" Distance to nearest: Well .............. .... ...-_--. ---- -:....Foundation :Prop. line ..-......_........._.. t REPAIR/ADDITION(Prev. Sanitation Per it# ........... ._.............. Date --------. ........... --------- Septic Tank (Specify Requirements) .. )pj/ I�p1y� ---- .. ... ...... Disposal Field (Specify Requirements) !.U_4--- - ------ -------• ------------- ....................................... .............. _. - ......._ 1....... . . --- -- -------- • (Draw existing and reqbired addition an reverse. sid•'e)" 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 Regulationsto of San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of-the�"rk-for-which this permit is issued, I shall'not empioy any person in such manner as to become sub'ec o orkman's Compensation laws of California"y t;` Signed .... . ... -. `.. Owner ` 1 BY ..................... .Title ...... . (if h r than ow er . �:; ,._. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ........... .........._...... DATE . .. 1 BUILDING PERMIT ISSUED ---•----------- ......:......................... ---.DATE ........_....:..._........._............ ... ADDITIONAL COMMENTS ............... .........................'.. .. -------------------- - ..------------ -------.--..... . .... ._ _............ _....._........................ ..------- ._.. .....:. - - -- - .. ..... v4 -------------------- y i_ Final Inspection by: ..l/�� - ------ ......................................................----Date ..�.. .v ..........----..-- 1 SAN JOAQUIN .LOCAL HEALTH )DISTRICT E. H. 1-3 24 1-'68-Rev. 5M . :r - 7172 3 M '�