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FORFOFFI E USE: APPLICATION FOR z. 7�- 77 • ---. . . _. R SANITATION PERMIT �/ Permit No. ..................... (Complete In Triplicate) .......... .."•.......................................... -.'•-- ..._ ., ... ..-•... .... ..................... . . .I 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 compliance with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATI N , .' ....................CENSUS TRA'7 Owner's Name . :.. --•- Phone... 7 Address ................ ........ City ................................. •-•••-..... Contractor's Name .... _. y<C ... . ............----.License # .-�•/.7/Phone `?._„lF. ` Installation will serve: Residence A artment-House 0 Commercial Trailer Court Motel ❑Other Number of living units:----- Number of bedrooms ---- Garbage Grinder ............ Lot Size ...fid'. . ....,...........,W Water Suppiy: 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 sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK,f ] Size- _,�..�___�(_..L�_.___ Liquid Depth ..0 _. ia:.................... Capacity la_n... Type ..�.......... Material.-r �- --..... No. Compartments p ; ' Distance to nearest Weil ......... ..... Foundation_.. .. Prop. Line ...1 el.. .. LEACHING LINE j j 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 Depth ... Diameter [ 1 p ................. ................ Number ----------�:-•-----•._.._._. Rock Filled Yes ❑ .No Q Water Table Depth ....... ........................................Rock Size ................................ Distance to nearest: Well ............................. ....Foundation .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ................... ----------------- Date 1' Septic Tank (Specify Requirements) ------------------------------ ' I Disposal Field (Specify Requirements) -- f- -------------- ° � d . a..�, ---------------------------------•------- ------ . ............................................... .............................................................. (Draw 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. Horne owner or licen- sed agents signature..certifies+the.folIowing: -�- ' "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 become subject to Workman's Compensation laws of California." t. . Signed .. � ............................ ......... Owner ?. By .......... .- ---Manowner) i� Title ............------......--------....................................... : If of r t OR DEPARTMENT USE ONLY y A—— APPLICATION ACCEPTED . •-- --••--••••-•-•••••••---•-•--•-•-•-•-•-----•-•----•••--•---•--•---•---•....._. DATE . _. .......... .... .. ......••--. BUILDING PERMIT ISSUE _ _._......... DATE ......................__._...._...ADDITIONAL COMMENTS .............•----..........._._.......---••-•--------•••-•---=-•••••--•-...-- •--••-_.. ..-•.................................... •••--•-------------•-----••......--------..:_..._.............-•-•-••.............-•----.................------•••••.` ...:.:....:.................................................................................. ..................................... . ._..-•--....-----••------•--••--•- , : ....................... ..............I........................ ..... G/ .....•--••--------••----.......-•---••----••--- ...Final Inspection by. Date 7 ......... SAN JOAQUIN 19,C�A5 HEALTH DISTRICT E. H.13 241-'68 Rev. 5M �73-M