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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' ... ................•--•---•-------•----- - Permit No. ....-7..-•---........- � (Complete in Triplicate) ' Date Issued l -.-.- _................... This Permit Expires 1 Year From 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. 549 and existing Rules and Regulations: JOBADDRESS/LOCATI :�.-�.7p."',....-n:..... .. �...............,_.r::;CENSUS TRACT .:.....:.:....:........... Owner's Name — ...«.`-.r.............. ......... ............. -. .................... . ......... ..... ......Phone'- .... ............... Address . ` ... ..... .:_: ...--......2—S--7• ?. ....... city .:. .......... .... ... .. ...-.:..................................... F �_ Contractor's Name ._�. .... ._. ... :.....-License # cam. ... -._ Phone ........................... Installation will serve: Residence C Apartment House-[3 Commercial f❑Trailer Court 0 I Mote( ❑Other .. ----------- Number ther .....::.._--•- Number of living units:......I-... Number of bedrooms _._.�.:..Garbage Grinder ............ Lot Size ....GG7��rb c,u,,........ Water Supply: Public System and name .................: - r Private (� Character of soil to a depth of 3 feet: Sand❑ Silt C] Clay' Clay`❑ Peat❑ .Sandy Loam 0 Clay Loam 0 L, . . _ Hardpan Adobe Fili Material ............ If yes,type ............................ j (Plot plan, showing size of lot, location of system In rejati'on. 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. ] Size... ............................................ Liquid Depth ..................._.::fV Capacity .................... Type -------------------- Material--- •- ---------- No. Compartments ......................� Distance 4o nearest: Well ...............................__.._Foundation ...................... Prop. Line ................... LEACHING LINE [ j No. of Lines ------------------------ Length of each line.--_-__--_...__..._..._..... Total.Length ............................. D' Box Type Filter Material Depth Filter Material ............................................ Distance-to nearest: Well ....... ....:: Foundation ....... Property Line r SEEPAGE PIT [ Depth -------------------- Diameter—................. Number ............................ Rock Filled Yes ❑ No Water Table Depth .............Rock Size 'y Distance to nearest: Well _______________________ M ...............Foundation .................... .Prop. Line -•-•---...---------•-� REPAIR/ADDITION(Prev. Sanitation Permit# .. Date ''I Septic Tank (Specify Requirements) Dis asci Field (Specify Re uirements _____________ . { c.... . .............:...- .��-... -- -. .- _�-...... .................... ........----•-•-•- .............- .......................... (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 Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the worn for 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 By ... ?10, Q --- -•------------••• - Title : ......•---------------•--- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......... DATE .-- .. ... � .... ,S.r....___ BUILDING PERMIT ISSUED _...- ... . ...............:........_.....::.........---:...•-......---_...... --•-- DATE ._------......; •----- ------------- ---- - - ADDITIONAL COMMENTS .._. G. . -----••-•--•-- . --•---------•....._.._... ........- ----------------•---•---------- ............. ..,. ��.. ..................................•................ --------.._: .......................................... ----- .-..-.......... ......................... ............................... ... --- -----.....-----...--••-•----- --...........................-_..._......-•---.-..--.... -........ . ....... . . . , -. . ..... ..................... Final inspection by .. .................•- Date ............,... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1_'68 Rev. 5M 7/72 3 A