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FOR OFFICE USE: APPLICATION FOR SANITATION- PERMIT . .,, .-........-----•...................:.............. Permit No.: 7.... � (Complete In Triplicate! ................. ... 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 ADDRESS/LOCA N /...Ga..l a.....4..5.. .... ...f�. CENSUS TRACT _ 'owner's Name ........ ................ ........ ..................... ............................... e ..,... ..Phon Address �. 0 ...-.-. r .. r_....._.................. City . --•-•-......`............... ` Contractor's Name ------ ...............................License # .,� ._ Phone Installation will serve: Residence Apartment House] Commercial❑Trailer-Court C] Motel 0 Other __...................................... -- Number of living units:........ Number of bedrooms _.._.Garbage Grinder ............ Lot Size ............. Water Supply: Public System and name ..........................................................----:......................---•-......................PrlvateR Charocter of soil to a depth of 3 feet: SandE] Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 Hardpan Adobe 0 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 t SEPTIC TANK %a - am. -..-:- . Liquid Depth�. .......................... _..-.- .CapactY��D� 7YPe No. Compartments ...................... � i r Distance to nearest: Well -. QQ.......................Foundation ........... Prop. Line ..... ......... LEACHING LINE No, of Lines ....0................ length of each lined-- -y-A�� .� Total length ..... ...._.... 'D' Box ... Type Filter Material 4/?0. ..-Depth Filter Materla! 'f......................:.... f r Distance to nearest: Well ...,/1 ...-.. Foundation .. ............. Property Line n SEEPAGE PIT ��j Depth --p2-S--------- Diameter ....... Number .......... .............. Rock Filled Yes W No �0 1 of ." % Water Table Depth --- DQ. ..........Rock Size .c7 ................ � Distance to nearest: Well .../--_--_-------------------Foundation ..... Prop. Line `.. �/,f' REPAIR/ADDITION IPrev. Sanitation Permit# -------------------------------------------- Date ..................................) Septic Tank (Specify Requirements) ...-.................................................................................................. Disposal Field ISpecify Requirements) --------•--•--------------................................................................................................I.......... •-----------------------•--------------------------•------------------•- -----------------------------........ ---------- -------------------..............- ---...-- •--•........-•---•---....------...................---......... (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 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 beco. object to Wor an's Compensation laws of California." Signed -- :.. - L3" ! Y� .......... Owner f� !4' BY _e - - ------ Title ------_4- --- (if otht an owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......C9i-----.-•--- DATE ./. ... ..... _-7C BUILDING PERMIT ISSUED ___........ DATE -- ADDITIONALCOMMENTS -----------------................. .. .................................... ------------ ......... -------------- •-------------.....-------------•--,-.-....-----._....-- ------------------------------------------,---------------------------------------.---------------.. . -•-----------......._ ----------------------- ----------------- ------------ -----------.............•........---------...------. --------.._.....-........... .............. ........... i FinalInspection by: -•--...�-_ -`-..rt�----- -- --------------------------------•-•--------•--•---•-- --------------------------Date �.Z J EI 13 2b 1"68 Rev` 5M SAN JOAQUIN LOCAL HEALTH DISTRICT �I J