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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT g ........... ........... Permit No. .75-. / (Complete in Triplicate) ........ ....... ............................ Date Issued 6'"1-7S_.................... This Permit Expires f Year From Date Issued ...........I........ 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 m�addee in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO . ...../-�. ... .... ................. TRACT Owner's Name . .. ................... ------._.. ._... .---•------ ... .............P on ---................. ........ Address -� Phone �� .�.. y• •..............................................,......:.... l•e: cif Contractor's Name . Q�----- _ ------ -- - - ••--------•.License # ........ Phone ..................... Installation will serve: Residence Apartment House-0 Commercial ❑Trailer Court ,❑ Motel ❑ Other ........ Number of living units: . _ _... . Number of bedrooms .._`_Garbage Grinder' ._...._.... Lot Size ..•.. ._ � ......... Water Supply: Public System and name . .....------ ------ ......... ............ ....---------..................................... .... Private Character of soil to a depth of 3 feet: Sand ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _.._. ... .. If yes, type ...... .... . .... i (Plot,plan showing size of .l'ot,..location of system in relation to.wells, buildings, etc, must be .placed on reverse SW) i+1EW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l ' PACKAGE TREATMENT [ ) SEPTIC TANK [ ] Size------------------ ........ ........ ..... Liquid -Depth - ............:_.......... Capacity Type ----- --. - --_ --- Material . No. Compartments ....... Distance to nearest: Well -Foundation Prop. Line ... , Oq LEACHING LINE [ ] � No. of Lines - .� Length of each line ' ...... . .....Total Length ................ ...... .. 'D'" Bpx : . Type:Filter 'Mdteripl Depth• Flit'er"Nlciterial' _ s`. Distance to nearest:-Well _.._._:_- foundation .: ..:.: .:.::.:..,:.. Property tine :------ SEEPAGE -_-.SEEPAGE PIT'. [ ) Depth Diameter. _:. Number :_ Rock Filled Yes ❑ No ❑ Water Table Depth ... ..._...._......... Rock Size ... Distance to nearest: Well -.-. ..Foundation... .:. Prop.: line i.. P. REPAIR/ADDITION(Prev. Sanitation Permit# ..._.. _ , Da ...... Tank (Specify Requirements( : .. . ._ L fie --�---- ------•i --- -------- --------------- 0 posal Field Specif Re uirementsC f.�' _ �.F •6L. C?..� i ;.,. v. Y q ] --•- ........ Dis ` _..._- ... , .. ...................._....-- --_ ... . ----------------- - ------... -- • ---- ......... ... .... ...... .. ....---.... ------- ----------- ----.. (Drdw'existing and required addition 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 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 become.•subject to Wor Compensation laws of California. Signed .7.7�. - ---- Owner .. ...._......._.._.• By .. . _ . . . . - - --- -.. _. --------------- ------------- --- Title .(. If other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY .. ..... DATE .............•- BUILDING PERMIT ISSUED ......... ..... .. ...... ........ ----- - ._ ..DATE . . ......... ------ -----•-- , ADDITIONAL COMMENTS .......... ... ..... .............. .....----• --------- --- --------------------- _ ..... ..................... ` Final Inspection by: .. ---------------------------=----- :....Date ... "o�_S " � SAN JOAQUIN LOCAL HEALTH DISTRICT } E. H. 13 241-'68 Rev. 5M_ 7172 3 M