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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..7.. . ..... ..................................... rt (Complete In Triplicates _ ...............:..............•---••--•---•-............. _ - Date Issued ... This Permit Expires t Year From Dato Issued ......-•---.1.1:...---- H 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. 519 and existing Rules and'Regulations: ....................CENSUS TRACT .._.. JOB ADDRESS/LOCATION ..........Phone 13.,... .x.- Owner's Name ....J..c� _ _ l� i-•-•1 �'c1.5 - :--..•. "1.�_. .Q`r..7_.....--- ............... ---•---•----- Address 1.� _?l.........fd.l.�L.i_G..i*.......... .......... .. ...... . - Contractor's Name ---•---------••-----•----- •------ .................................:..•--...License # ................. Phone ..... _....... . .Installation will serve: Residence 21 Apartment Hotise 0 Commercial❑Trailer Court ❑ Motel []Other •---•..................... Garbo a Grinder .1V.�Lot Size --- `d. 1.�G�-••••.•.....--- l�umber of living- units:... �___ Number of bedrooms '�.- 8 --••- -- . . Private ❑ Water Supply: Public System and name _. .14. _�.JE __....__ .......................................... Character of sail to a depth of 3 feet: Sand❑ - Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ --....1f yes,type ............... ............ Hardpan Q Adobe a -Fill Material ...... (plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated on reverse side.) 00 feet,) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 2 . �.�.�. Liquid De PACKAGE TREATMENT I; I SEPTIC TANK I I Size..__ lea��it wG- - . q Depth ..................._... -- No. Compartments ............ -... - Capacity --�-AO.Q.... Type .............. Distance to nearest: Well .....Foundation ........ Prop. Line......................• t , . Len th of each line.....--•............-•••--- Total Length ............................ rO LEACHING LINE [ ] No. of Lines ----------------••-•--- g Type Filter Material ..Depth .Filter Material .............•-..._..........` 'D' Box yp ............... Line ........................ Distance to nearest: Well ................•--•-- Foundation ------------- ..--•• Property SEEPAGE PIT [ j Depth --•-•••---•-------.. D+ameter Number ............ ........... Rock Filled Yes ❑ No �7 ...---•----- I Water Table Depth Rock Size ................-........ ...... foundation ...... Prop. Line ...................... � Distance to nearest- Well .......................... ---.....----•- REPAIR/ADDITION Prev. Sanitation Permit 5lf ........ Date ................................... Septic Tank (Specify Requirements) -------•-------••-..... ...-r... .... -- ......... ^ Disposal Field (Specify Requirements) - .-� _y.G,,s L 7�' -------- ----- ------------------•------------•---------- ...........-........................................................................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done is accordance with San Jeaquln County Ordinances, State Laws, and Rules and Regulations of the 'San Joaquin local Haatth:Distriet. Home owner or licen- sed agents signature certifies the following: person In such manner "I certify that in the performance of the work for which this permit Is issued, 1 shall not employ any as to bAcom ,,b*co Workman's Compensation laws of California." Signed . Owner ........... ... Title -------_------- -- .. (If other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - --- BUILDING PERMIT ISSUED .......-----------......................................•---•-------.. . ---------------------_--..DATE ............... .................... ADDITIONAL COMMENTS __-•-------•------------ ......I.............. ........................- --•--- __.._.... : --------•1------- -- :-.._.. ._.. --- --- --- ---- -- ------- Final Inspection by: �� - EH 13 24 1-68 Rev. 5N SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M