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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT c., .......................•------•------=-----•--••--- ...�.:.3� -- (Complete in Triplicate) Permit No. _ .......................... This PermitExpires 1 Year from Dafo 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 5' a existing Rules and Regulations: JOB ADDRESS/LOCATI /. ... _ .... ...� ...... CENSUS TRACT .......................... Owner's Name - - ,/ ...............Phone ...... . v. Address ----... ..----- •---......City .r.................. Contractor's Name .-•• .. . .. .................... .. ...4t.-r. . ...............License # ,f..05�� ✓----- Phone y - » Installation will serve: Residence []Apartment House E2 Commercial❑Trailer Court 0 Motel ❑Other Number of living units:___ Number of b ra .Garbage Grinder Lot Size Water Supply: Public System and name __ .Private 0 Character of soil to a depth of'13 feet: Sand'] Sift Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe [] Fill Material ............If yes,type ............... :........... (Plot pian, 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 j ] SEPTIC TAMC Size �- .----...X.�:_.X../.5............. Liquid Depth -- q Pt .............. v ... Material....--. Capacity- :_- TYPe No. Compartments ..: Distant . two wnrea_ st: Wel- . ..........Foundation ...................... Prop. Line ..../..Q.. ..... . LEACHING LINE j I No. of Lines .....14 Length............... ngo h eacI e_ 1�= �:. ._'....__ Total Length e r - 0 93 0 r 'D' Box ......___.- Type Filter Material epth .Filter Material ... ------------------ Distance to nearest: Well ........................ Foundation ........... Property Llne .--- .................. SEEPAGE PIT { I Depth- .................... Diameter ................ Number ..............-------------- Rock Filled Yes ❑ No Water Table Depth -----------•-• •-••-"---:_....--•---•--...---..Rock Size -------- ....................... Distan'ce to nearest: Well ........................................Foundation --- ................ Prop. Line ...................... EPAI A DITION(Prev. Sanitation Permit# ................................... Date ._................................ ' Sei�Tnk cif Re uirements(SpecifyReq uirem osalField osal Fieldents ) ................. •------------_------_-- .................................... ---- .............. ------------------------------------------ ------------- -------------- - ............................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the ward will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrlct. Home owner or licen- sed agents signature certifies tate following: ".I certifythat inPormo a work for which this permit is issued, 1 shall not employ any person in such manner as to b8came Wo s work ion laws of California." Signed Owner BY ---"" ---------------- •----------------- --------------------------------------------------------- -Title (If other than owner) 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .- - . , . r n s ' � -.-.-._-.-.-----i----- - DATE S ...... BUILDING PERMIT ISSUED ....DATE --- ------------------------•-.•..-.-.-_ADQ1TIONAL COMMENTS --- "--- --•-----•.-._: -------------- Final Inspection by: _.. _.._-- ••--.- - Date........ _ .+�� .............. _ -------• .--"----------- EH 13 2L 1-68 v. 5M, SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7a 3M