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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ;Comple in Triplicate) Permit No. .7-3 7 ... .... This Permit Expires f Year From Date Issued Date Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install`the %b ork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules aed Regui ions: JOB ADDRESS/LOCATION .:./.. .._. <h !'...�c1n _..... '._ ` i' '9cNSUS TRACT ...: ..•........... ,/� Owner's Name ---- �!b/ '"..7�i' ........................... .... ----------.....................Phone .._.................. .............. Address ....... � ---•---tv.- --------------- — City --------••-------------...................:......-----....-..--•---........ Contractor's Name ._._oon--e............... ............ ..................... .License # ...-_._................. Phone .............................. Installation will serve: Residence;gApartment House-E] Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:...../__. Number of bedrooms .."arbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name -.............................................................................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ Peat[? Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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 seweris available within 200 feet,) PACKAGE TREATMENT E ) SEPTIC TANK,r ] Size....................t..._.____.... --r..__.._�.Liquid Depth Capacity -------- Type Compartments .. ..._....Foundation------------------------k. Prop. Line __`...._•_.... . Distance to nearest: Well _._..._CfZ�..'_.,_.__ � 4..LEACHING LINE No. of Lines fl----... Length of`,each line. .0Q._' . -' ,ft Total ,Len th ...A .P........ 'D' Box -----4--- Type Filter Material '4- �--_Depth Filter Material ..fir- � k , -� oundation .... Property Line Distance to nearest: Well's � � F .._. .:.. SEEPAGE PIT [ j Depth --------- Diameter "Number ................ Rock Filled Yes ❑ No Q j Water Table Depth .� -= `-` Rock Size - ------_...- ---... •••..... ..................•-•........_.. Distance to nearest: Well ........................................Foundation ........... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#-------------------------------------------- Date ----------------------------------) ; Septic Tank (Specify Requirements) ........... DisposalField (Specify Requirements) ----------=--- ..................................................•--.............•--------------------- ---------•----------- r-- _. . ___7 (Draw existing and-re46ired 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. Horne owner or licen- j sed agents signature certifies the following:: "I certify that in the performancelof the work for which this permit is issued, I shall not employ any person in such manner as to be le to kman's-. m ensation laws of California! Signed � _---.. -._:�_-� ..'--.M_�..-Owner 1. P Vi By .. . ---------------- •--...- •-------• : Title ..._..__.._......---._......_..__....._...._..._......-••--------....:.> (If othe than owner) I i MR DEPARTMEN USE ONLY APPLICATION ACCEPTED BY-- �.._..- DATE .... .^" f- -.-- i BUILDING PERMIT ISSUED ............. '......................:.----.........._..:...:.... DATE ............... ADDITIONAL ADDITIONAL COMMENTS ...-•---•-- ...- .................. ..................... = , --------------------------------•--• = ---••- i Final Inspection by: ............ .............Dat _...... ._.__...... w SAN JOAQUi�sI -LOCAL HEALTH DISTRICT P 13 24. ` E. H. l-'b8 Rev. 5M __ . 7/72314 j