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FOR-OFFICE USE. _ 1 APPLICATION FOR SANITATION PERMIT- C � (Complete p ) a:� it No. ..................... " * Perm in Tri licate ThisPenult Expires 1 Year from Date Issued r Application is hereby made to the San Jooqui local Health District for a.permit to construct and Install the work herein described. This application is made In comp j nce with unty Ordinance No, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATiov ,.,�3.5 00�... .. ... .... ...... . ........ ......,................CENSUS TRACT .............. .... a3— lc 16W. Owner's Name .... .. .................. ..:................Phone . . ..,.......... .,. _•_ Address . ..... ..__. ............City ... x ►�--.........-•---. .... camR Contractor's Name ......YJ:t..Q-.s......�:!?-',L.��;:.. .. _ .�.. -:....Liven:e ilt `�.,��.... Phone .:�.�:''�.��..®,7.. � Installation will serve: Residence�Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ......................................... .. W Number of ,living units:... ........ Number of bedrooms ...&..Garbage Grinder ....... Lot Lot Sixe .. ..�............... Water Supply:.Public System and name .._.:--....... .... .Private ..... _................................................... Character of soil to a depth of 3 feet: Sand b Silt❑ Clay [3 Peat❑ Sandy Loam❑ Clay Loam Hardpan r] Adobe Fill Material ............ If yes,type................ ............ F (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 ( ] SEPTIC TANK ] Size....................... ............. Liquid Depth F •, Capacity .................... Type ---------........... Material ......... No. Compartments Distance. to nearest: Well ....................................Foundation ...... ............... Prop. Line ................... :.. LEACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest.. Well ........................ Foundation` _....................... Property Line ........................ SEEPAGE PIT I I Depth Diameter Number ..:......................... Rock Filled Yes ❑ No ❑ Water Table Depth ---•.................................•--•• ----Rock Size ..................:...:......... ' Distance to nearest: Well ........................................Foundation ................. Prop. Line ...................... REPAIR/ADDITION(Prov. Sanitation Permit ................_........................•--- Date .................................. F Septic Tank (Specify .Regwrements). ...... • ................................ ........ .... Di poso) }Field {Spec' Requirements) . .:. ., R �i_. �._.... _..o_�.r' o4r Q , f ........... .................•------...-..........._..._............ ....... -----•- --_--------�....................................._.......................... IDrow existing and required addition on reverse side) . I hereby certify that 1 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.Disttid. Herne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, 1 shalt not employ any person in such manner as to belm�eAub1 c to Workman's ompensati n laws of California." Signed BY ------------------------------------------ ------------ -------------------•-------._...._..--•---..... C ._ ....... Title .: ... ------------------------ ------ (if other than owner) FOR DEPARTMENT USE: ONLY _ APPLICATION ACCEPTED BY ----e�' .--------------- •-----------•--...--------- -- DATE,..�; � BUILDING PERMIT ISSUED ....................................... . --- .•-----........._....--......_... '-------•--- ...............DATE ._-........._._............................. ADDITIONAL COMMENTS ................................... ... -------------------------------- ---- ......................................-.-..-.............................................................................. .... --------------'i '----- ----------------•------------••---•---- ••--- ----- . ...:........ - f-----------•-------------------------------------------------•.......--......Date ../.......--•--_._J . .......... Final Inspection by: ..�f2 . EH 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M t