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FOR OFFICE JUSE: APPLICATION FOR SANITATION PERMIT v� .a b....... (Complete in Triplicate) Permit No. Ll '? " ........................ •••. •---• 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 complia a with County Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION ..... ,.Z-C],.,.._. . .... .............................................CENSUS TRACT Owner's Name �.._ ---•--. Address .--•....................... .. . y.CQ ..................... Phone . $ .' 561...._.__. City Contractor's Name ............ ...License # 3_ Phone . Installation will serve: Residence;64partment House 0 Commercial ❑Trailer Court 0 V Motel ❑Other ............... ........••-----••---...--_-_ a, ar 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❑ Silt❑ Clay Q Peat C] Sandy Loam 0 Clay Loam ❑ Hardpan C] Adobe 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 C ) SEPTIC TANKf ] Size'..-............................ ..•-_.. ------- Liquid Depth ............... . 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: Wel( ........................ Foundation ........................ Property Line SEEPAGE PIT [ j Depth -------------------- Diameter Number .. Rock Filled Yes ❑ No j]G Water Table Depth ................Rock Size G Distance to nearest: Well Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit;# .................................... Date ) .................... ...........•_--••----...-•---•---- Septic Tank (Specify Requirements) ...................... ---------------------------I--- ----•--- Disposal Field (Specify Requirements) 77_.. ...... Q-...._I.,&— •C✓L__•-• SL'..�7.�.y ' ........-•.................I.................... ........................ .........1............ ........I................. (Draw existing and required addition on .._..._._....._d. -. -------------••---•-.-.-.•----- ---•--- reverse sie) • -• 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. dome owner or liven. sed agents signature certifies the following: "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 to beeome subject to Workman's Compensation laws of California." Signed ..... . Owner By ............ .... .... ----.... --------Title --------... •-- (If other t a owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. �... • ................................................. BUILDING PERMIT ISSUED �77 7' ..........r.. .......... .. ........... . .......... DATE . ADDITIONAL COMMENTS ..........:::::::......::::::::::: ---- ::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :: :::::::::::_:::::: :::::::::::: ....... ................ •.-- Final Inspection by -•--•-----------------------•- ..............................Date ... ..t. ... . ................. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1.3 24 1.'68 Rev. 5M 71721 K