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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT iComplete)fn Triplicate} Permit No. .....--•••---•"• ......-" _. This Permit Expires f 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 egulations:JOB ADDRESS/LOCATION .._..... - ... -- CENSUS TRACT K Owner's Name .......... .......... ----- ---••-•--•--... .. - o . _....Phone --- Address - ---- __� [ fl�� •--... .......... City . .. ".--------._. S .. ... Contractor's Name ...._.._.... ---. S-------- ---------------License #a5„3 StK .. 3” Phone6i6.-_ 6� ' Installation will serve: Residence (Apartment House In Commercial ❑Trailer Court ❑ Motel ,❑tOther --------- ---, ,.. .. -•- ------ Number of living units:......r_... Number of bedrooms ../74-___Garbage Grinder ------------ Lot Size ................. tib'.---..... [ Private ,.. .Water Supply: Public System and name .........____ � ---•..•_•-• Character of soil to a depth of 3 feet:- Sand `•Silt❑--"Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ t - ,Hardpbn ❑; Adobe ❑ Fill Material ............ If yes, type ..... (Plot plan, shaw�ng 'size of lot i'ocatson of system in relation-to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION- (No septic tank orlseepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANKk �' Size _ P Size.-.. . Liquid Depth_ --... Y�Capctyf -Ype Material. .cry.... No. Compartments . ...... .....:.J D�istancert ebre`st Well ..._�-cor•�---------------Foundation /Q -•--"-. Prop. Line "`LEACHING LINE $ ""3 [� 6 [ ] No. of Lines Length of �adt line.... .. (r .'............. Total Length ��:�_.----........ D' Box .._t! Typ ilter, Material .- -- - ..---Depth Filter Material .._/. .f .......... ............. Distance to nearest: Well �?.�.' ..-_-.- Foundation 1P.7K.-_-.._.._ Property Line �� r� E PIT [ ) Depth Dia eter ....... :..._-- Number -_. P � SEEPAGE p .__ Rock Filled Yes ❑ No [,] Water Table D th -I --•- ----------------Rock Size . .................. Distance to nearest:-Well ......... Foundation .................... Prop.-Line __........._._..._._ - E REPAIR/ADDITION(Prev. Sanitation Permit# ..._......-. Date ------------------------------- Septic ----------------------Septic Tank (Specify Requirements) Disposal Field (Specify�Requirements} -- - ...... .................... ......... ...- .............. ............ ----------- ------------- ........ .1 _._. - ---- ..---- -- ..... -----:..-t ' - - <" {Draw existing and required - i i on on reverse side) her certify that I have prepared this,applicatio t+d thd�, alis. ork will be done in accordance with San Joaquin County 0idinances, State Laws, and Rule -and Regui tions o1 t, n'Joaquin Local Health District. Home owner or licen. sed agents signature certifies the foliowi ' "I certify that in the performance of the r rk for which this perm is issued, I shall not employ any person in such manner r as to become subject to Workman's Ca nsation lawsof C lir ornia." SignedA Owner -....-- BY .... ': Title . ,.., . j2, ------- fother than owner -__ _ .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. DATE :.� - �, - ,BUILDING PERMIT ISSUED ....... ............ ........ ------••--------- .........� DATE _ ....._._-._. _ ---•-- "ADDITIONAL COMMENTS ........... .......L._... ----...._....-----------•---.... _ i Final Inspection by: .._ . _. ---�..---------------.......... --------------.......•----Date . - -.:.... .._. . ."..:....-•----._. SAN JOAQUIN LOCAL HEALTH.DISTRICT , 13 24 �r E. H. 1-'68 Rev_&hut