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FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ...... ............................................. .... ...% "s�. � 'l ` Date Issued ..��..:�:6.�73 ........................................................ This Permit Expires 1 Year From Dat*Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIONJ ...................................CENSUS TRACT Owner's Name .!'J!t.. f.l?:.......... ......... .I. ............. ........Phone ....... Address ...............................f7..�.�.........�:©..........l )�i �...iJ�{aCity ........ r�G.h.fl?�........................... ... Contractor's Name ................ f ( 1�_�..$---, !Q.�t1,C�.-�N'C--.___.....License # Phone �?. .:.� .�.`.1... Installation will serve: Residence❑Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ............................................ Number of living units:......... Number of bedrooms ....Garbage Grinder ............ Lot Size ... ........... Water Supply: Public System and name ......................._....................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe �( Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth ........................... Capacity .................... Type ................... Material—................... No. Compartments ...................... 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 lino SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth .............................................. .Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) Septic Tank (Specify Requirements) ........................................................................................................................................... Disposal Field (Specify Requirements) ...0 .,......../..Q.D......... 1.an-e.4..4.1*! ...................... ........................... ........................................................................$......3?"..x...1;2-!�.`........6T........................................................................ ....................................................................................................._......................------........-----................................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be don* in accordance with San Joaquin County Ordinances, State laws, and Rules and.Regulations of the Son Joaquin Local Health District. Meme owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work 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 . ._.:.... L. .............................. xitle .......: ............................................... . (if other a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . ... ................................. DATE ..2.. . BUILDING PERMIT ISSUED .............. ................... ....:... . . .............DATE ADDITIONAL COMMENTS.... ....... 5. ........... ..i. ................... ......... ...�...... ............ ............ .� . 3. .................................................... ........................... Final Inspection by: ........ ...........................................................................Date .......? Q1023 SAN JOAQUIN .LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M