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FOR OFFICE USE: \ ' APPLICATION FOR SANITATION PERMIT _.._ k Permit No. ... t (Complete in Triplicate) ........4-A�. ............ ..........I This Permit Expires 1 Year From bate Issued Date Issued .'-.._'x!l.�T 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: j JOB ADDRESS/LOTION r �... ..��.. �L # ...rt'�'........................CENSUS TRACT ..•....:.:...::....__ ..: Owner's Name uS6...--- . . f.. ................ .:- _ Phone ...........................:.......: Address7 City ........ _.. _ -•--- ........... rr Contractor's Name .__.. __License # -_1.�i�. k. hone _ ." F . ...... ..:...... Installotion will serve: Residence ❑ Apartment House 0 Commercial oTraller Court 0 a Motel (]Other .........4, ............... Number of living units:. ........ Number of bedrooms _.!''..Garbage Grinder .......... Lot Size --• ........ ..... ............ Woter Supply:-Public System:and name:....:------ ---------• -•........:........---•------------••-....._......------.........I__..._._..-----...._Private ®� r Character.of soil to a depth of 3 feet: Sand 0 .Silt[:] Clay 0 ' Peat 0 Sandy loam ❑ Clay Loam �! Hardpan [] Adobe 0 Fill Material ---_-.__-... If yes,type ..........................•. I (Plot, plan, showing size of.,lot, location of..syZge in relation.to wells, buildings, etc. must be placed- on reverse side.] ( NEW INSTALLATION: (No septic tank or see pit permitted If public sewer is available within 20'0 feet,) ! PACKAGE TREATMENT [ ] SEPTIC TANK y Size r lj a �� ..._. Liquid Depth ---•-- .................. Capacity _6.: . Typ _ _Material. . No. Compartments ...2::�...... o Distance to near st: Well ....................................Foundation ..../A............ Prop. Line LEACHING LINE No.`of Lines ..._.j.... .... ...... 'Length of each .............. Total Length .... A..*. D' Box -__:__._. - Type Filter ....Depth Filter Material -----/.T_..f_•.•.... ....... Distance to nearest- Well 's0.1..._._""Foundation ....!/�:A... ....._ Property Line S- � < • .. � - I - - ---..... .......... SEEPAGE PIT [ Depth _... Diameter .., ._ti_ ^Number ...........�[-------------- Rock Filled Yes No � ` ii �f t Water Table De th �,T_Q_ ... .. ...............Rock Size .. distance to nearest: Well .......... Q ...Foundation Prop. Line REPAIR/ADDITION(Prey. Sanitation'Permit# _....:...................................... Date .................................. Septic Tank (Specify Requirements) --------- -------•----------................... ------------•----•.......................................,........................... 1� Disposal Field (Specify Requirements) ................................................ ................................................................ ............... ............. - ......-•-------------------.------------•----•----........----------------•-----....._.............I.__........_I...---- l. w (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 followings 66 1 .certify that in the performance of the work for which this permit is issued, I shall not empioy any person in such manner as to become subject to W n Compensation WWI of California." Signed .._._._..:_. _........ . ...... ........... Owner g . By ...............................•--• r ��s 1 Title ..... ..,.. . _ ..__ .... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-/' ..................................................... BATE ofd � ,t� ,..._._.... BUILDING PERMIT ISSUED ......-DAT#: .............. ......----- .................................... ADDITIONAL COMMENTS ...::_..:...__..,. .................................... . .... Final Inspection by: ... .. r* ......................................................_._Date J...'.. _"_r�_ ....:._._....--- __ _ T SAN JOAQUIN LOCAL HEALTH DISTRICT y _ / E. H. 1-3 241.'68 Rev. 5M 7/72 3 M