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' y _ . ♦4 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r �..5. f... Permit No qds... k (Complete in Triplicate) ............................... ...................... --•- Thi: Permit Expires 1 Year From bate 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 compliarice with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....... ..`.. ..-:. ------... -r................._........_CENSUS TRACT ......................... Owner's Name ....... . ...........................:............... .....Phone _..�•-a�_r ._e �.o Address ...... .. .. -- ----- Q' .... ..................... CitY Contractor's Name # ,1�!'1�.. Phone . s Installation will serve: Residence Apartment House'❑ Commercial ❑Trailer Court Motel ❑Other ............................................ pyo r, RNumber of living units----- Number of be rooms -Garbage Gr€nderl Lot Size .... f. --. • ......... Water Supply: Public System and name ...... Private Character of soil to a depth of 3 feet: Sand 0 .Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ \ 1 Hardpan ❑ Adobe K FilI Material ............ If yes, type ------_----------------_ I (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[ ]mss tASiaB.............................................. Liquid Depth ..............-........... Capacity ...............__ Type,•--J--------------- Material---------------------- No. Compartments Distance to nearest: Well .................Foundation ...... Prop. Line LEACHING LINE No. of Lines y ..... ...............:. Length of each line.-- --( L?._..----•_-.. Total Length ._ -•---_-•--. ' 'D' Box ...( __ Type Filter-Material .. �.�d .Depth Filter Materia! _�__. �� r / r Distance to nearest: Well .. --__---_--- Foundation /�i_________________ Property Line ....47. SEEPAGE Depth ,%j .._ Diametor,44V�._. Number .....1........... ...... Rock Filled Yes '' No C1 l Water Table Depth ____-_- _ ----..Rock Size . .� xxl� Distance to nearest: Well ......oel .�__________________Foundation ........ Prop. Line _.__ .............. REPAIR/ADDITION(Prev. Sanitation Permit 5# ......................................... -- Date ---.-----.--.-------.-.------.--•.1 Septic Tank {Specify Requirements} ................. ....................... -•---- . -- -- . --------------•---............ ........ Disposal Field (Specify Requirements) � {T........ ....... ---- ---000 -----------------------------• --------................................................... ................._ ............... (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 to become subject to,Workman's Compensation laws of California." Signed ........- ........................ ---••-•.... Owner By __....... .. --• - Title _ ..................... (if other than owner) OR PARTMENT USE ONLY APPLICATION ACCEPTED BY ......�� ------ - --------- � DATE .......lJ- •• t—.. .. ...... BUILDING PERMIT ISSUED ...., .d----- -------_ ...............DATE ADDITIONAL COMMENTS .- _..�� 7. .... ... _................. i ............................................................•-•----•--.............--•-----•--.._..---=------------------........---.....--•-•------............------........---------•- --------------••---- -----------•- ------------------7_1 ..........----••-• -----------.-.------•---------•-•-•-••-•--•----..........._..--••-•--------- -- ................................ "AN -----•............................ Final inspection by: . .............................................................Date . ��.... r_.. . N 'LOCAL HEALTH DISTRICT �•�,� E. H.13 241-'f:8 Rev, 5M 7/72 3 M