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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT l` (Complete in Triplicate) Permit No, _..---••-•...................... -. ..--.... This Permit Expires ] Year From Date Issued Date issued �/ /3_.._';?-3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ..... __.; .__ ..-...��,...._ -� � ............ ......CENSUS TRACT ....... ...... Owner's Name ..._.__. ... ,.� Phone I Address City . ._._ . _ Contractor's Name ------ -. ` ' t..Litense Phone '�.�.+� Installation will serve: Residence (Apartment House] Commercial ❑Trailer Court Motel ❑Other ...................... Number of living units..__...- Number of b rooms ... ....Garbage Grinder .._. �v �f� r Lot Size Water Supply: Public System and name ._.. �••_,._. --...... ............. Private ❑ ---••---•-•-------------•----••••• - Character of soil to a depth of 3 feet: Sand D Silt❑ -Clay ❑ -Peat❑ Sandy Loam ❑ Clay Loam n z Hardpan (] AdobeA 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 ], � 7`r '�Sia®------• _----- ................................. Liquid Depth .......... Capacity .................... ----- Material-------........ No. Compartments Distance to nearest: Well ...... . . .... ..... .... .......Foundation ...................... Prop. Line ...... N LEACHING LINE No. of Lines Je r 1� I Length of each line..-- --.--••------ Total Length _../,�f .............. 00 'D' Box . .. Type Filter Material xC .....Depth Filter Material ._ ..... Distance to nearest: Well Foundation __ _.� r rn - .._......_ Property Line �`"..--_•---_-•-.... . SEEPAGE PIT Depth 1:;!1Z19 ......... Diameter ......... Number ..._.__..�............... Rock Filled Yes No �]� Water Table Depth r r 0 •------ ••----- ? •- -••- - p• �......... _____ ....Roc Size Distance to nearest: Well .�(..�.-�L' .............Foundation ��._.. Pro Line ._.. a REPAIR/ADDITION(Prey. Sanitation Permit# _.........____. pate ............. Septic Tank (Specify Requirements,; -------........-------------- r � , .. 1/. ._. -tintDisposal Field !S ecify quirems} .... .e � " s ---- ..--- -------/ �1... . -- - --- ----------- ----------•---------------•----- -•------ (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 I 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 ..------- ....Title (If other than owner) ' - .................. g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._ ..__ _ --••-•------------------------------••--•-•-•--••...--••• ...... DATE .... BUILDING PERMIT ISSUED .... . ..------•-•......::.........••----......--..._.._...•---•-....._.......---..........DATE ...__._.......---....... .ADDITIONAL COMMENTS ...... ...........{._.........------ ------- ........... .....................................................-. •......_...�. .._......--• -----.•---...... ................................ .__._.._....._...__._.._ :__ _ Final inspection by: f • -- ...... ...... ._ . �...... ---• - -•- ----•-••--••------•--------....................................._....---......---.....Date ...��.-�:1.-...�_2V....------....... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M