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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ICompletein Triplicate) Permit No, .7 - _96 This Permit Expires I! Year From Date Issued Date Issued Jf:"./c..:-7y. 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/LO TION ..�Q��o`r.. ...... .-...CENSUS TRACT .......................... Owner's Name ....... . --- •--- Phone ............... *� � •----..-...- .-....-_.. Address - . City 4 Contractor's Name .. .- r'.. , L License # -�g� '_ Phone .................. .. - Installation will serve: Residence Apartment House-❑ Commercial ❑Trailer Court ,❑ Motel ❑ Other ------- - --- -- - ....................... Number of living units:.. . ... . Number of bedrooms ., .....Garbage Grinder .. . Lot Size Water Supply: Public System and name ----------------__------------_• Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay j] Peat E) Sandy Lgam 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size. _ -1 _ . .6 " �/ , r� X. .......• --- -. - Liquid Depth . T•- •-•....... Capacity it 2;n b . Type�,ll.rtE. .- /Material... Cr-�-4ZNo. Compartments p .�. Distance to nearest: Well J�Q_-................_.. .......Foundation -. ..lQ-�......... Prop. Line -. ..�..--•---••- ii LEACHING LINE [ ) No, of Lines Length of each line a Total Length -...rZ ....._..I....... .-_ 6 'D' Box Type Filter Material ....._.....- !�.-.-Depth Filter Material .---.�-�................................S Distance to nearest: Well -. ...7��_.�........ Foundation /Q. ......... Property Line ...J5'................ SEEPAGE PIT O Depth . Diameter ---------------- Number ...........- Rock Filled Yes ❑ No ❑V' Water Table Depth .- _ ------------Rock Size •-------------•.............. 9 Distance to nearest: Well ........................................Foundation ............ ....... Prop. Line ..-_.--... ....... REPAIR/ADDITION(Prey. Sanitation Permit# -------- -...... ... ............. ....... Date --------.----._...--.-------......) Septic Tank (Specify Requirements) . .. .. . ..............._. ............-•------- ......-- Disposal Field (Specify Requirements) -----------------------------•- ---- - _- i . .. ........ . ...... . ---- - ------- -------------.......... . ----- (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. 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 td become subject to Work 's Compensation laws of California." Signed .._. ... ... Owner /- By .. . .---.. ...... .... ... ._ Title H- _......... . . (If other owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE . . BUILDING PERMIT ISSUED .. . . . ..... . . .. ... DATE . ADDITIONAL COMMENTS .... ........... -----------------•--•----------- .....----.._. ............ ------------------ _---- ... .--- -------.-----.-- ..-........ Final Inspection by: ..,. . = - ------- ---•---------------------- --------------------- -Date rj ..�: . SAN JOAQUIN LOCAL HEALTH DISTRICT a E. H,; 1.3.,.241-'68 Rev. 5M 7/72 3 M