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FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT ' ....................................•.........._.---.... 7G —392 lComplete iris.Triplicate) Permit No. ..................... :............ ................ ......... �--3 ?G ........... ..... This Permit Expires 1 Year From Date Issued Date Issued .._..--••---...._... Application is hereby made to4he San Joaquin Local Health District for a permit to construct and install the work herein l described. This application is rr'ade in compliance wit County Ordinance No. 549 and existing Rules and Regulations- JOB ADDRESSAOCATION ....... .7J,�. - -=... ...•...............:..............................aNSUS T ........ j 4 Owner's Name ._.._....._ �`Ua_. .. --• . ........................Phone ......- �.T . Address. .................... ... .•-- .................I City :._........-••--... ....... --- Contractor's Name ..............License # Z. _�� a�_-_ Phone .. ..............?!! �/' Installation will serve: - Residence Apartment House f] Commercial aTraller Court'0 j a Motel ❑Other..............• -••---.....------•------- F 1 Number'of,.living units_____________ Number of bedrooms Garbage Grinder tot ize Q.__....._.. j Water Suroply. Public System and name . to 1❑ ..................Priva Chotacter#of soil to a depth of 3 feet:r Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam❑ r Hardpan ❑ Adobe Fill Maer�ial ......... If yes,tYPa ............... ............ . I (Plot plan, showing size of lot, location of system,trelation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tan" 110 seepage pit Fpermitted If public sewer is available within 240 feet,) PACKAGE TREATMENT [ SEPTIC TANK } 5iie.......--------------------•............,....... Liquid Depth ......................... .-� Capacity •------------------- Type --------•----------- Material .................... No. Compartments .......................r " 'h Distance to nearest: Well ........Foundation .................. Prop. Line Is,- LEACHING LINE [ ] No. of Lines ........................ Length of each line..__..............___.._..___ Total Length- ............................ E 'D' Box ............ Type-Filter Material ....................Depth Filter Material. ......"........._......= Distance to nearest: Well ........................ Foundation" ............... Property Llno. ......................... SEEPAGE PIT ( } Depth ------_-----.-_.... 'Diameter .......__-_.- 'Number ................... Rock filled —Yes ❑ No Water Table-Depth "---------•-- ........... ---_-------------Rock Size --••........... ........•--•---- �. Distance to nearest: Well .---_----------- ----------------------Foundation ---- .__..._...._. Prop.11no ...................... REPAIR/ADDITION(Prev. Sanitation Permit# _..... -------------- Date .. .._---------} Septic Tonic ;(Specify Requirements) ............................. .......... _ f - - ---- - -- ------------------- Disposal ---- -----------3isposal Field (Specify,-Requirements) . ----- ----- - --------- Y . -------------- ......•-------------------------------- --••-----------------°----------- ......._................-------------------------------------------------------- *...... ............. . (Draw existing and required addition on reverse side) I hereby certify that4 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 Heatth,Distriict. Homo 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 emplay•any person in such manner as to become subject to Workman's Compensation laws of Califorriiti." Signed -- -----•-• ------ . _.. .. Owner ---•----------------------•-•- By �..- -------------------------------------------- A.. _., _----- ---------------------- Title ------ � -( f of r han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE 3 �d BUILDING PERMIT ISSUED - • .. -- -------- ..............DATE ........................................... ADDITIONAL COMMENTS ---------------•---- ---------'-------------------------------- ::_ ....................... -- - - =} ----- - - - ---- ---- --------------- ------= - _.._- . - - --- -•--- ----- --•. ..................... final Inspection b ..__Date .... . -- F� Y= �� - 7 7-a............... EH 13 2L 1-68 -Rev. '5M" SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M