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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT , - Pennnit No. --- .............. S (Complete In Triplicate) ....................... ................................................... This Permit Expires ] Year From Date Issued Date Issued ._. ..7y Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5.44 and existing Rules and Regulations: i JOB ADDRESS/LOCATI _.I-3�_ �.T.e..lC .T./...Q/../._ t�/A/ ......CENSUS TRACT ...:...........:....::.:.. Owner's Name ..... . ` -------- ........................ ... ......_. .Phone Address .-- fr. ,... ._....�s` .... ...............I.._......_.... City ... Contractor's Name � f ................................. _.•._ ._ ......."-.License #,,V.2947/... Phone ', Installation will serve: Residence[]Apartment House J3 Commercial @Wailer Court ] sF Motel ❑Other Number of living units:.._/----- Number of bedrooms _�,_ .G rbage Grinder Lot Size7 , ............ and nWater Supply: Public System ....... �---•- _...................................................Private 0 Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe E�- 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 [ ] SEPTIC TANK,[ ] Size................................................ Liquid Depth .......................... L.. CapacityType .... Material .. No. Compartments ut 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: Well .................. Foundation ........................ Property Line SEEPAGE PIT ( j Depth Diameter ................ Number -------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ..............Rock Sire Distance to nearest: Well .............. .........................Foundation ..... Prop. Line ---------..____------- REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -..._-.._____._______._____-_____- Septic Tank (Specify Requirements) ----------------- ................... •----.. ------- Di sposal Field (Specify Requirements) .. ......�s�._-____ _ ,��" ' E ........... ---------------------------------------------`----------•-------------------•------- ----------------------------------- -----------------------•-•---•--.............. ------- { t -•--._.I.............. (Draw existing and required 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. 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 Workman's Compensation laws of California." Signed .......... -- --- --- ` ------ . Owner BYCom..- .......--"-....... Title ..._ — ."""_....-.""-""-.-.-".----"•----•--------. (If other than ow erl J FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED 13Y ...-7.. .--- •-••- . �/ ^ -'---•-- ------`--------•----------. DATE ....46',_X.. -•-•--• = - BUILDING PERMIT ISSUED -----•- ...--`-----`•--....... ............ .DATE ....................... ............... ...... ...........................•--...-•------..... ADDITIONAL COMMENTS ...:........................... ..._.._..-•.................................•---"--•--....--•---.............._.................._. .C-:....... . _.....•..................-------------------------.......---.._.......,.....- f --------------------------------------- ...............•... ............................. ...................... ........................................-_........................... __....._............................................. Fina{ Inspection by: Date ... •--....., .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.:13 24 1-'68 Rev. 5M 7/723-M- -