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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- Permit No. {Complete in triplicate) _ = Date Issued This Permit Expires T 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 my Ordinance o. 549 and existing Rules and Regulations- JOB ADDRESS/L O :.....CENSUS TRACT ....,..................... Owner's Name .__� ............ -•------•--• .......................::............................Phone ...n-lk.- / ?.41- Address ... .41-. Address •�- "�..... � - -- • .. ............-- --------- ......... ._......_.._..._......__....-------•..... City ....................... ................................._................ Contractor's Name r---------------------------...License r .. f...._ Phone Installation will server Residence 0 Apartment House Commercial❑Trailer Court ❑ Motel ❑Other .......... .......... •------- 7 Number of living units----- Number of bedrooms .� Garbage Grinder Wl. lot Size L. ! ._ _X. . .. .......... Water Supply: Public System and name .........•-..............................................__.....................................................Private ❑ Character of soil to a depth of 3 feet: Sand Pk Silt.[ Clay p Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe D 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK Size .---....- Liquid Depth .... ................. Capacity - -------- 7YPec ' `- Material.................••--- No. Compartments .... .... --- --•-- ..... Distant to ne st: Well _.. _ .........Foundation ...................... Prop. Line . LEACHING LINE [ ] No. of Lines _.-_. •--- ------ .Length OF eachne_�1 . 6--��bta1 Length .............. a 'D' Bax -----------:Type= - .Filter Material Depth .Filter Material .......ac............................. Distance to nearest: Well ... Foundation Property Line ........................ .-------- . _ •------------------- Diameter ..._......_.__._ Number ............................. Rock Filled Yes ❑ No SEEPAGE PIT WateDeptr, 0 Table Depth --_.---Rock Size ................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... . (�E Alli A ITION(Prev. Sanitation Permit` .......................................... Date ..................................I SepticTnk {Specify Requirements) ------------------ --------------------- .....•---.......................................................................................... osal Field (Specify Requirements) -------------------- 1 ----------•--•-••-•-•-• = ..........._.-,.......:...........--------- ------------------ --•---•-------------- - ..-_. --- (Draw existing and required addition on reverse side) I hereby certify that I have p►epared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Lawes, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: "I certify that i hep rforman of work far w h this permit is issued, I shall not employ any person In such manner as to beco is o Wb a ' ompensation ws of California." Signed ... ------ - ------ ------ ---------------- Owner �a BY -....--------------- Title - -------------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------� --• - --- .---------•----•------•----------- ------------ ---------._.. DATE .� 2"r/ � ._................... ADDITIONAL COMMENTS ---- - --- -__ -----DATE ---------- - ------------_.............. BUILDING PERMIT ISSUED ................. - -- ------------------ • ---- -- ---- = ---------------- ._.. final Inspection b �.__..._. p Y: ..--------- ---• -• .......... ....................:....................�----•-------...__._._......_........._Date _.......... ------....__.................-.3 EH 13 2a 1-68 ltev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M