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-'FOR OFFICE USE: ........................I. ... .. APPLICATION ICOR SANITATION PERMIT .....................••................_. ............ (Complete In Triplicate) Permit No. ......... This Permit Expires f 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 Regulations: JOB ADDRESSAOCATION . . ..._ Owner's Name ......CENSUS TRACT Address ....... -..�,..- -.2. - - -��...................................... ...........Phone .......... ..................... . Contractor's N city -... •._...---*..._.... . �� ...License Installation will serve: Residce .. Phone ................ en Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ............................. --•-••• ---•-- Number of living units:..... -... Number of bedrooms _... ....Garbage Grinder ......._ ... Lot Size .....-.--.- Water Supply: Public System and name ................. . . . Character of soil to a depth of 3 feet: Sand 0 ...................................... .................. ......Private Silt❑ Cla Y ❑ 'Peat El Sandy Loam -❑ Clay Loom ❑ Hardpan Adobe ❑ 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 p bile sewer is'avoilable within 200 feet,) S PACKAGE TREATMENT ( } SEPTIC'TANKN d C+!'� l Sfae _=./r.{�_--7..f��`-.f Liquid Depth t i � Capacity_! � T ex r ..............•0 YP � ..-. Material....a.. No. Com artments • p �f ....... .. .. Distance to nearest: Well ..... Foundation .Zd9--Z- _- _ ............... � ... Prop. Line LEACHING LINE [ --•-=� - -•-••••••••Z No. of Lines ...__s-------_----- Length of each line.- _ - ..... I._ Tota! ,Length .e.6� 'D' Box ............ Type Filter Material ...t-�.........Depth Filter Material Distance to nearest: Well ._...7 - Foundation SEEPAGE PIT [df Depth ? i / Property Line .. ..... Diameter ._� _ . Number .. - C](b . � - �................. Rock Filled Yes � No Water Table Depth Rock Size 4, 41 .. . Distance to nearest: Well .-......- .. 'r ~� ................Foundation ....��,� Prop. Line ......��.�.. REPAIR/ADDITION(Prey. Sanitation Permit# .....................•-•-_ pate .� ................ --- y Septic Tank (Specify Requirementsl .................. -•---............................. _..... Disposal Field (Specify Requirementsl -.......___. ..�..._ .---•----•-•-....- • ------•---------------------•- ...................._............- ----•-•- ------ ...................._.................. (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 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 subiect to Workman's Compensation laws of California." Signed ................................................ Owner _ title .- s ...-.... (If other than owner) •••••....................... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... DATE ...� - 4..7,. ........ BUILDING PERMIT ISS ....................................••---•----•-•----....-..........-.._.......---•---•--� --• ADDITIONAL COMMENTS --•...' -----.....•••••.... DATE .............. ....................... Final Inspection by: -------""' .� ............... . .•-•--...-•----......._ .................................................. .......Date •� � ..........-- SAN JOAQUIN LOCAL HEALTH DISTRICT I3 24 E. H. 1-'68 Rev, SM 7 r