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y x � FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......._.: ...................... . Permit No. .. (Complete in Triplicate) This Permit Expires 1 Year From Data 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 egulations:JOB ADDRESS/LOCATI N , .. 6 D._ a_. �1- _•••..._I——........................CENSUS TRACT .............-•.-„.......... 1 Owner's Name .... ._ � �.............I.. -.T---...�.. .I............... • ---.. ....Phone ........... .. Address 3�.. �s._...� 1�.. ............. City :_........ ----- -------- --- - . - Contractor's Name ......_:__. ........._ ' .............. ..License Phone . .�..� ......_..... Installation will serve: Residence$Apartment House o Commercial ❑Trailer Court 0 7. Motel ❑Other ............. •................... r ' Number of living units:..-/------- Number of bedrooms ...7�.Garbage Grinder .. . ..._._. Lot Sire :. - ...x�_ �................ Water Supply: Public.System and name :.. -_---------- --------------•••----._,.._........-•---•• ..--•-- -••-••--.... --•• Private • ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat❑ Sandy Loam ❑ Cloy.Loam ❑ Y - Hardpan ❑ -Adobe Fill Material ............ If yes,type ...................... ` buildings, etc. must-be„ side.) i (Plot plan, showing-size of lot, location_afsystem .in relation to well.s, placed on,reverse_ NEW INSTALLATION: {No septic tank or seepage pit permitted if public ewer is available within 200 feet,) , I PACKAGE TREATMENT -1 ',SEPTIC TANK J ] Size.....................______.._ ----------------- Liquid Depth ........................... t _ ^Na. Compartments 6 Capacity --------------•-•`-- TYRE -----...........�... Material....-------------- ................_...._� Distance to`nearest:—Well` ....`::•:----'......................Foundation --`--•-•---...------- Prop. Line ...................... LEACHING LINE ( 3 No. of Lines ..........:............. length`of each line------------.......--------- Total Length _._.......... .............. D' Box ..Type Filter Material-......'...-..__:.. Depth Filter Material i Distance to nearest: •Well ........................ Foundation,,... .__..........._.. Property, Line ........................ (0 7 SEEPAGE PIT [ ) Depth :---.--..:.,,-Diameter �:.:. �. '� -Number ............................ Rock`'Filled ' Yes ❑ No Q s WaterTable-Depth ..::.:.......: : .........................-...Rock Size;-------------------------------- - Distance to nearest:.Well :`"`. ....._ Foundation x Prop. Line .............. ------ REPAIR/ADDITION(Prev. Sanitation Permit# .........:......' Date . ..........................� 1 ••=--•••••-- Septic Tank (Specify Requirements) ............. .. . ..__... ------... ...... .......-..... { Disposal Field (Specify Requirements/ ... ..�f a '` V=` •-- ------- - - - - -- ------------- ---------------(Drawaxis#Ingand required - addition on reverse side/ I 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 Scan 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California,” Signed ._,_ "r .""" �. Owner Title .....By ............. -----•... .............. f if of than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y�....r.......... ..... .,� ---•-- J------------------•-•---• DATE . 1�.. --.�...,?_ BUILDING PERMIT ISSUED DATE ---------------------•---• ---..... ADDITIONAL COMMENTS . •. ::... ------.--------- ........................... ..._.......--•••••_.. .............. ....................... ....................................•-.............................................•..................................I............. ------- .:._. .... .. ..... ... .. .... -- ._ . ......... r Final inspection by: ......: &� .................................................:......... Date �`� �� 7 SAN,...JCtAQUIN LOCAL .HEALTH DISTRICT.; ._ � .._.,• .._ . �,..,.,• ........ w .- . G u=13 241_-Aa ne„ gAA 7/72 3 M