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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 --. .....-----»---��-.,3�?.._.__ Permit No�T :...3.7_1(.. {Complete in Triplicate This Permit Expires I Year From Dat*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 ADDRESS/LOCATfON .... �J CENSUS TRACT Owner's Name ... .�f ..J� ........................................................Phone ................................ Address ---------• ... City ...� ------ Contractor's Name __. r=- -_.License # c �l�•1�y Phone .�� .. .Q � Installation will serve: ResidenceeApartment House Commercial OTrailer Court 0 Motel Q Other.............. ................•--........_ Number of living units:..._l...... Number of be ooms _j....Garbage Grinder ............ Lot Size ....'ham .7C - �........ Water Supply: Public System and name ...........Private ❑ Character of soil to a depth of 3 feet: Sand b Sil Q ..._..Gay 0 Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan❑ AdobeQ 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 1. Size..........:.....:.:.::.:................. Liquid Depth ........._.:.............. X l S . ........... ,L)c Capacity ......... Type ------------_----- Material.------. ---- No. Compartments p Distance. to nearest: Well ....................................Foundation---------------------- Prop. Line r LEACHING LINE [ ] No. of Lines ------/-------------- Length of each ch line...... ..._ Total Lenngtth�... . w �j�15�r"lrlr D' Box �x _ Type Filter Mate ial ..�.4.-XA/epth Filter Material .....Id..................... r /1 Distance to nest: Well .. �^+ Foundation __/a............. Property Line .. ......- � SEEPAGE PIT [ ] Depth _.. --------- Disameter_ ...__ Number ......._.. ./__..::. ...._... Rock Filled Yes 9__9_0__ t_ rya Water Table Depth lg; _� "`' . -R& Size .. .%s �s. ....._-•--- ------------- Distance to nearest: Well __., ..............Foundation G7.. -_ Prop. Line _... .............. REPAIR/ADDITION(Prev. Sanitation Permit#----------•--------------------------------- Date .......................I Septic Tank (SPecify Requirements). ----------------- - Disposal Field (Specify equlrements),_- -- - --------------- ��.....�t �. .._.......... . ...� x. - .. . .......... __------------------- ............................................ , P(Draw existing and required addition on reverse side) 1 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;Dlstdct. Hoare owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit-is issued, t shall not employ any person in such manner as to becom tilect to offs an's ompensaflon laws of California." F Signed ------ .-- ........- Owner 4 .. By ------------------------------ i_.. ----------------- Title (if othe tha wner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. DATE. ._:.,__.._ ...... . I• - BUILDING PERMIT ISSUED -------------------- DATE -------_-----_----- -- .------_--. ADDITIONAL COMM -i 7 - --------------- ---------------------------------------------- ............. .............. ................. Final Inspection Date ..... ._. ._ ....... ' ES 13 24 1-68 Rev 5M SAN JOAQUIN LOCAL HEALTH DISTRICT /7h 3M