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FOR OFFICE USE- L310d Q-1— " APPLICATION R SANITATION PERMIT (Complete In Triplicate) Permit No. ..................... This Permit Expires 1 Year From Date issued Date Issued �- 7� 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 Regulotionss c JOB ADDRESS/LOCATIO � _ ...�2... ........... --•---••..................................... CENSUS TRACT ... .............. Owner's Name ��-�....... Phone . l..z -. - Address ............. {4 ._. City Contractor's Name f --- -- .....................License .............`. ' Phone . ... Installation will serve: Residence t6 Apartment House Commercial❑Trailer Court 0 Motel []Other............................................ Number of living units:.---- ----- Number of bedrooms --- ?- Garbage Grinder of i .. x ....� Water Supply: Public System and name ' pp Y . --••••••-•-----•..............._-•-•----•........... :w........ . -- - _ ...Private Q Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe\0 Fill Materlal ............ If yes,type............... (Plot plant, 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 ifublic(sewer is available within 200 feet,] Q PACKAGE TREATMENT [ ] SEPTIC TANK tA Liquid Depth .............. Capacity ... T e ._ Ty -- Material �i_ No. Compartments Distance. to nearest: Well ....................................Foundation ........ Prop. Line ........ LEACHING LINE No. of Lines --_.--- _ • •------ ---. Length of ach line ------- ....... Total Length 'D' Box ......... Type Filter Material : Depth Filter Material _-_ ............................... Distance to nearest: Well ............ . Foundation ----l.44.--'J Property Line !�:. 111T O Depth ..../.0---------- Diameter .X- ....... Number ........._-' R k Filled Yes No C1 s 3 �,r Water Table Depth ----------------------- ................_Rock Size ! Distant: to nearest: Wel! -----.--•-•-•- Foundation ._..1 --Jf-.. 'Pro . .. p. Line ................. REPAIR/ADDITION(Prev. Sanitation Permit{# ..............--_.-•. ------- Date Septic Tank (Specify Requirements) ...................__-- ................ ......................-......................•——.................. .......... Disposal Field (Specify Requirements) -------••------- � � ..`' ------------------------------------------------•-•---•------------•-----••-- (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 Son 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 ---- � r Title . L—v� {If other t n owner) --------------•••--- ------------.-. -------- .......... ................ OR DEOARTMENT USE ONLY APPLICATION ACCEPTED BY--- .. DATE .._.5. ..-- --.� _- :. . BUILDING PERMIT ISSUED -..- ---_- •-_ ,_ DATE -------------•............................ -------- -•--------•-• -------------------------------------- ADDITIONAL COMMENTS ----------- ------------------- _........ .. ------------ --•---------- --• ................... ---------_- r ----------------------------•----••-•..._..- Final Inspection b P y: .......... -----• --. ............- ----------------.._.........................---------.....................Date --- --• - -- - -- - • EH 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M