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FOR OFFICE APPLICATIGN FOR SANITATION PERMIT " z . .................................. 1 -3 f (Complete in Triplicate) Permit No✓ .._:.?A .. .... This Permit Expires 1 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 ADDRESSJLOCATION ../.__L...----✓r_.... ,.... �Lr ............................................CENSUS TRACT .. .. ................ o Owner's Name .:. . ...- - - -- --- - -........ .................................••-............................ .Phone Address _ .�.�j....._.V..... ----- 4,4.4................................................ City .........---............................. Contractor's Name .........................License # ------------------------ Phone --- .......................... Installation will serve: Residence P-4portment House Commercial ❑Trailer Court 0 n Motel ❑Other ................ ...... ---•-- ............. Number of living units:............ Number of bedro S ._3.....Garbage Grinder ............ Lot Size ..r7x..1'.S.6--._-•---_---._� Water Supply: Public System and name . -- ----------------.--------- --------.-------------..................._...............Private C]Character of soil to a depth of 3 feet: Sand Q Silt[] Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe ag Fill Material ............ If yes,type ............................ r (Plot plan, showing size of lot, location ofsystem 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 TANK'[ ) Size-----------------------------------•------------ Liquid Depth ......................... Capacity /19 0p....... Type . ..... Material------------ No. Compartments Distance to nearest: Well .................................... ............ ..............Foundation _ ._ _..._.... ...................... Prop. Line .----..........._..._. LEACHING LINE [ ] No. of Lines .....3--------------- Length of each line------c7--9..._........... Total Length 'D' Box .....t----- Type Filter Materia# ..[. . ..depth Filter Material r��.................................... Distance to nearest: Well ..... Foundation ...a2 ... .__ -Property Line ...Z?.' ........ SEEPAGE PIT [ ) Depth ... Diameter .:.............. Number ---------------------------.. Rock Filled Yes [] No Q Water Table Depth ...........Rock Size + Distance to nearest: Well ................ ._._.Foundation .................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ... -•....... ............................ Date .......... ...................I / m , Septic Tank (Specify Requirements) ... ......................7 _-- ....... ....... f Disposal Field (Specify Requirements) -------------------•------------......-------------•-- ,------------------ --------------------------------------------------------------------------------------------------........................................ .. (Draw existing and required addition on reverse side) ' 1 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 licew sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as tosubject to orkmC", rgpens Laws of California." Signed .�.�_: .... , ................. Owner y By ........................................... ......................................................._,.. Title ........................................................ -----•--------- (If other than owner) FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY ...-- .s._... ........................................................ DATE BUILDING PERMIT ISSUED .................... . ...........................•...................... ...DATE ....../.........._..•-••_...----••....... ADDITIONALCOMMENTS . _...................................•---...----•---._...--......_..--------•---..__........_ .................................... ------- ........ -------•--.._.... .............. --•----------•.........-----------------...-----------•---•••-•--.._....--•-•••••--•-•••-•----•---._.....••-•-- --- ........... ..................... FinalInspection by: ----- - --- ----- -- ------- --------------------------------------------•----.........••-- ••---••-•..Date ... ...... w SAN JOAQUIN LOCAL HEALTH DISTRICT r,� ` dCD E. H.13 24 1.2'68 Rev. 5M 7/72 3 M