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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........ ...... ..-._....._ ............... Permit No. ...7T.��7� (Complete in Triplicate) :. ;ol .................... ... 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. 6.49 and existing Rules and Regulations: r �"4 O JOBS_ ADDRESS/LOCATION C ._. _. .. :-�� ./ ......................CENSUS TRACT ..................... _.... c. ..n . ' - Owner's Name - Phone Address v�G/ ---------- .................... ... City --- �Ea` y.._. --D---- ___ License # ...:.......... ...:.. Phone Contractor's Name ..... .�a1.--- - --- ---..�t�:-� �•�r/ __.. ..:...----•-•---•............. Installation will serve: Residence P5"Apartment House❑ Commercial :[]Trailer Court 0 Motel []Other ............. . Number of bedrooms 0......Garbage Grinder ............ Lot Size ......... ............. Number of living units:___/____ Water Supply: Public System and name ............................•........................•............--...........................................Private Character of soli to a depth of 3 feet. Sand❑ Silt❑ -CIiSy w❑ Peat Sandy Loam ❑ Clay Loam ❑ (!� Hardpan .,Adob�`�Fill'Material ............ If yes, type -••-------------•--•---..... (Plot-plan, showing size of lot, location of. system 1 in relation to wells, buildings, etc. must be placed on reverse side.) { NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i Sized(."s[.AP _X..5.`................ Liquid Depth --- .............. ff d xi Capacity ..-1�Pp----__-- Type dUlateriai___QflJ�c�____.... No. Compartments ... _........... Distance to nearest: Well ............t°- ....... ..Foundation ..__._/V-.-------- Prop. Line ........... ( Length of each line.__....._ 9._�--------- Total Length ..�`v . LEACHING LINE No. of Lines ......-•�---•__-• ................ � 'D' Box Type"Filter Material ......-.-ter.&......Depth Filter' Material .......If . Distance to nearest: Well ......... Foundation .......1o_.'....._.... Property Line- __:5'..�.. ....... SEEPAGE PIT [ Depth ..... .' _. Dlameter Number ........ ................ Rock' Filled. Yes No C3 Water Table Depth 1..... ...............Rock Size ...11..... 3......... .Distance.to nearest:Well ..............:Da. ..._........Foundation ---eel.......... Prop. Line -----_____--__._- k REPAIR/ADDITION(Prev. Sanitation Permit ..........--------.-------------------------- Date .................................. r { Septic Tank (Specify Requirements). Disposal Field (Specify Requirements) ...--•------...--•-•---......•••-•-.........-•-------•---••-----------------•----•----.........----------------......._..._._....._.. .......------------------..............................................................................__.------_....___..._............._............. ---•...__....._................................ i .__..."...............................'-------------•---••------.._._...__..__......_.................---...-.-.---•--•--•--------_.............................._.•--•-•---•.._............ __..._...... ; (Draw existing and required addition on reverse side] . ; 1 hereby certify that I have prepared this application and that tate 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 licew sed agents signature certifies the following: _ I "I certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---=--_.__.. Owner i ------------- BY ..... ...... ..:........-------------.......... . ,lX�.. :. Title --- ..---• --= ................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... . . . . .. . ..... . . . ..................................................................... DATE ..a�� - .......................... BUILDING PERMIT ISSUED ----------------- --- =. __.___DATE :.:: ADDITIONALCOMMENTS...........................................-................................................----------------------------------------........................... .....................-...........................-•-----------• ••••...... . .... .....•. .. Final Inspection b :!.�' ................. ....... ...... --------------- ------Date .c......��. ... ............... SAN JOAQUIN _LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7172 3 M