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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................::. Permit No. ..................... (Complete in Triplicate) -•-------------- —.........._........ 7 '......................................................r.. This Permit Expires Year From Date Issued Date Issued ._�:..........�. 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. 544 and existing Rules and Regulations: ................... i JOB ADDRESS/LOCATION ,. ... _ � _.' .r...... ........r?.CENSUS TRACT �} I Owner's Named ................................aPhone`. . Address _.__... rt Com- . ------ ....... . ...................... City _.. --- --40, } ....................... Contractor's Name ............. .... ... ... .7,g, - ....:.License # .C-� _ _.. Phone : .17' Installation will serve: Resi e� partment House Commercial ❑Trailer Court Motel-❑Other : ...: . ::::........ Number of living units:------ Number of bedrooms _.....Garbage Grinder ......... Lot Size,._. .4�.. ...9C.? Water Supply: Public System,and name ........................ ...........-----_._....--_--:--------- -------------•-..:..............................Private ❑ ' Peat Sand loom Clay Loam I Character of soil to a depth of 3 feet: Sand�] Silt❑ Clay ❑ ❑ y ❑ y Hardpan ❑ Adobe.❑ Fill Material ......... If yes,type .........:...:.............. (Plot plan, showing size ofJot, 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 TANKf ] .a„r .�..�. .�Siae---, --.-. .-; �l-.C�.__.... Liquid Depth ......... ..-•------._,._... N Capacity/ ..00.. Type.. ... Material_._ ,� ._. Na. Compartments ^...... P ..... Distance to nearest: Well ------------------= 1....Foundation _1P............. Prop. Line .....7.............. LEACHING LINE No.;�of Lines -._-- Lengt'10h of each aline--_-_-- '"�"""' 'Total Length (_LC�.l�..:..............• V ' __; � c� Box .....:...._ Type Filter Material ....................Depth Fllter Material -__:-_._::_........_..:...._...... ......... Dist ....Distance Rock Filled vYesQ t Water Table Depth -- .............4.._._.__..Rock Size _ Dist once to nearest: Well ........................................Foundation ._....:.--- Prop. Ljne. -------....._. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------•--•---• Date .................................. SepticTank (Specify Requirements) .............................................................. -•-•- ---•----- ••••._ ---- -•--• -. -•-------- -_--------------- Disposal Field (Specify Requirements) ____________ _ ..:. r ------------------------- -----I——----------- ...................-A --------•-----------.....-•--•------------------------.......................... ( -----•------------ ---------•` - • ---------------•----------------------------- ..._.._........ .......----••--.--- i� (Draw existing and,fequired 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: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, l shall not employ any person in such manner as to become subject to Workman'i Compensation laws of CaEiFornia.'r Signed „ --.. Owner F� .................... Title If pheer T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . .............:.......................•--•--•--......--.... DATE ,�-_!!r_.-�7....---••---•- BUILDING PERMIT ISSUED .......DATE .....::.:.................................. ADDITIONALCOMMENTS ..:........................................................ .......................................................................p :............-......... ............................ ....•_...__..........••.A . .....4: ............. ...... .. .-...._...........__............__ r .._... .. ......--. . .... ..................................•-•---.......'_•-'-.---.._......__.. - __ - __ ..._._.._...... Final Inspection by: ....- :._.. . ...'..:, ' - ...-•....--.........•—.......................................... ... ..................... .... Date : .,' ...� ........_... ...... .SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3 rK