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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ............. Permit No. ..�'7.� (Complete in Triplicate) ..........................•--••------..-------...._....:_. ................................................•--_ This Permit Expires i 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. 549 and existing Rules and .Regulations: -30 ,1013 ADDRESS/LOC ION .5...,...'. `s .l``[ :. :.......... .1?`'.....��-r-� ..CENSUS TRAC"i _ ...... ................................... . Owner's Name '�� ' r�- � ... .._....-• ---.._.._.. Z.......... ........ Phone Address ._.._.....- - .....-- ........... City 4� ............... ... . . . .. ....... _.. :.. .. " t Contractor's Name - ...License #&2131?_ Phone ....:_._..._ r Installation will serve: Residence �partment House Commercial ❑Traller Court 0 L f �rr_ pp Motel ❑Other ............................................ ! � jNumber of living units:-.-..1.:.... Number of bedrooms ............Garbage Grinder ............ Lot Size ----- ----------'.__.:, N Water Supply: Public Systern:and name ..................�,1f:- h.............._.__.__.....-:---------..._..------- --------•-..__...Private C] }? Character of soil to a depth of 3 feet: Sand❑ -Silt❑ Clay ❑ Pedt o Sandy Loam Clay loam 0 } i Hardpan ❑ Adobe`❑ Fill Material ............ If yes,type ........................ (plot pian, snowing size of-lot, location of. system iri- relation to wells, buildings, etc. must be placed on revIside NEW INgAJLA�TJON: (No septic tank or seepage pit permitted if ,public sewer is available within 200 feet,)PACKAGE TREATMENT { } SEPTICTANK1l Size--------------•---.--.--------..._..-------_.--. Liquid Depth ..........Capacity ........--•------•-- Type ------•----•-----... Material...................... No. Compartments i Distance to 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 ._.................... .. SEEPAGE PIT [ ) Depth .... ......:... Diameter ...............: Number ---------------------_---- Rock Filled Yes ❑ No ❑ -w F Water Table Depth .........Rock Size ................................ t s Distance to nearest: Well ........................................Foundation ...__....... ....... Prop. ,Line ...................... REPAIR/ADDITION{Prev. Sanitation Permit# --•-•--•----................................ Date ................................ t. Septic Tank (Specify Requirements) ..................._ ..............-_-..-•------------............-------:.......... sDisposal Field (Specify RequirementTs) ..... ----- . . ......." •-----•- , -------•----------------------------- ---.-...-....._....---------------------•-.--•---....--------------•--.......---......--------..........-----••--------•----•-------.- (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 [icon. sed agents signature certifies the following: N, 1'1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workma 's Compensation J ws of California." Signed ------------------------------------ . Owner ............................._ ) - .:. a.... Title _ �� `'Z_ ._.........._._._._ By ._ ... �t 11 ....... .................. If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. _ fISSUED ...... - - - .......-----------•--------•------•..--•---............_....._. DATE ..��_..;�.��_�..----------•---- BUILDING PERMIT ............... =---------------------------- •---••---------•--.....--.........DATE ... .................................. ADDITIONALCOMMENTS:,......... .................... ............................... ................ � ...... ---•----------•.................................................... ............... Final Ins .. --------------- ------------------ . ._..._ Inspection b Date f P Y: .. t _ • • - ...-------•--•....................•••-....................._......__. 17�../- .... . I.....-- .... SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 7/72 3 M