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FOR=f?FFICE USE: °. APPLICATION FOR SANITATION PERMIT .. Q (Complete in Triplicate) Permit No. - This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described, This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ ,. _ .........................._........0E Owner's Name p S TRACT c�-.-.....•..J .. ..- ..._ .................... . . .. . ........... : .. one Address ' _._.. i-�1-�.._..... . .._.�.. city Contractor's Name .................... -------__._.License #� - t} Phone6� •-- . • Installation will serve: Residence�-W' Apartment House 0 Commercial {]Trailer Court �] �_ . .. - .,..� Motel 0 Other.. Number of living units:-----t✓..... 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❑ CIO',0 Pecgt I] Sandy Loam ❑ Clay Loam 0 r Hardpan El... ;Adobe 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 204 feet,) PACKAGE TREATMENT [ SEPTIC TANK{ J r„ Size...._._ A...--•:..._: Liquid Depth capacity Type - Material...........:....r..... No Compartments Distance to nearest: Well • - � .� - ...................... Prop. Line . LEACHING LME . "-""-"'••"---...... . [ j' ` Nic. of Lines .°__....--- �...'.....• Length of each line----------------------- . Total Length - _.- �) Type,Filter-Materiai .....:._. ":.. Depth-FiNer Material . 'W's Box ...,a_. Y ... .......... .... ---•-•----••...............................:V Distance rto,inearest: Well".. ' .. Foundation -•--..�..---...._;. .........-.............. Property Line SEEPAGE PIT [ ) Depth.. ' Diameter ..._..._..'... Number ❑...................... -- ..... Rock Filled Yes No >D2 Water Table Depth ......... ........................••--...........Rock Size -------•-•••. —s� , _ ow �.S�Distance to nearest: Well .......Foundation REPAIR/ADDITION(Prev�Sanitation'Permit# .1..� ...... Prop. Line ......... .............. Date Septic Tank (Specify Re uirements) _...... .................... ; -- Disposal Field (Specify Requirements) j" ................. Disposal ... �' e _..---•--... �C ................. 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 f County Ordinances, State Laws, a`nd'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 thispermit is Issued, 1 shall net employ a as to become subiect to Workman's Compensation laws;of California.,, p rn Y person in such manner Signed .................. _ Owner fl BY •• f i/(,f'M ... Title ...............�. (If oth an owner) ....................................................... OR EPA ENT USE ONLY APPLICATION ACCEPTED BYy/--- BUILDING PERMIT ISSUED •---•---......._. r .DATE . ADDITIONAL COMMENTS DATE .. ..----•--.. : F ;::...... ....... '�. ............::....................... •.--- ...............................:.::..... ...1�, / . ..._._. .::::::::.---............................:......::::__.... Final Inspection by: • • ::: ..................... .. . • ........... ...Date ..._��.. : SAN JdAQUIN -LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M � ._