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FOR OFFICE USI:: APPLICATION FOR SANITATION PERMIT permit No. ..._.3: (Complete in Triplicate) . •• -•.... This Permit Expires T 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: JOB ADDRESSAOCATION ,:....� ?�. ......... CENSUS TRACT' t.... Owner's Name ...t.__....... �. ............. Address .-.._..._ ....... ..•�.�. _..-...... . '.._...... ......... Phonel. :7..Z_.�4x�99, ....._: ..... _. ... City . __. . Contractor's Name ....................... -- ------ - :�_I.... -•.....-•____.. cense # Phone � 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:u - ••--- -- Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat[] Sandy Loam ❑ Clay Loom C] Hardpan 0 Adobe Fill Material ............ If yes,type ............................. (Plot :plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed'°oi� reverse side.) NEW INSTALLATION: ' � '`' ' , (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK [ ] Size.-•....._.':.............. Liquid Depth Capacity - Yp Material............. ... No. Compartments Distance to nearest: Well ......:..:..:...Foundation ...................... Prop. Line LEACHING LINE I ] No. of Lines .....-----•----•--_-_--- Length"df each line .............. ---- --` -----............... 'foto! Length A , D' Sox—..:_..--T ...Filter Material '�''� ...Depth, Filter Material ................................. .:... ` Y � Distance to nearest: Well .:...................... Foundation _.__.`_`s. .-`" -- Property Line SEEPAGE PIT rn [ j .. ,fir z .. Depth _ Diameter Number Rock Filled Yes ❑ No ❑ ` Water Table Depth Rock Size G Distance to nearest: Well ................... Foundation _ Prop. Line REPAIR/ADDITION(Prev. Sanitation'Permit# ---------------------- ............. Date �pw } Septic Tank (Specify Requirements) ............................. ; ................ ......... •••••-•....._....-•-----.__-_......... ..._....... Disposal Field (Specify Requirements) SC2 _ .................................. ..._..._••-...--•--•- ............. ___._____._-......---•-- ---• ......---••..............._—....-•••--•••--- ., ' .I.- _ raw existing and required additioh 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 dotal Health District. Home 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 By ............ .. ........ ---- Title (!f a than owner) O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY......... DATE BUILDING PERMIT ISSUED ADDIT! AL COMMENT . -.,,�. -- �' ...... ice:.. ...__. +.. . ..... -Wil'...... . .. _ " --....... . ..........�.... . FinaInspection by: ..... ... ..Date SAN JOAQUIN -LOCAL HEALTH DISTRICT E. H. 13 241-'68 - 7/72 3 ,K