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FOR OFFICE LISEs APPLICATION FOR SANITATION PERMIT ................................................. (Complete in Triplicate) Permit No. .7 S.......�'3... ....................................................... ......................................................... This Permit Expires I Year From Date Issued Date Issued pf, F-0-90-ce Application is hereby evade to the San Joaquin local Health District for a permit to constrict and install the work herein described. happlkationris_.. de_ir2 compliance with County Ordinance No. 519 and existing Rules and Regutcrtlonss JOB ADDRESS OCATION -....-- :. ....................'V ? .........................CENSUS T - ��............ Owners Name + d�:�.....r... ? ..fir ...... ..................... . .......... ............ .f hone .. - '----......../.. ... ly6................... .Ci :...........:.....,...._............._......... .......... Address �- City ..... Contractor's Name ..... ...:............................................................License ill ........................ Phone ......_ ...................... Installation will serves Residence M Apartment Houset] Commercial OTrailor Court Q , Motel Q Other Number of living unite:...I Number of bedrooms ...:5.....Garbage Grinder Lot Size ` '` Water Supplys Public System and name ...............................----------------------,.-,_................................................. lvate10 Character of soil to a depth of 3 feats Sand 13 Slit Q Clay .Q Peat Jo Sandy Loam ❑ Clay Loam Q Hardpan Q Adobe Q Fill Material ............If yes,type ............... ............ {Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side-11,;Z"' NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) p PACKAGE TREATMENT [ } SEPTIC TANK Od Slze.14..:t.6..4...Ir.-. .................. Liquid Depth .......................... Capacity&.ice.......... Type' . Material-A ........ No. Compartments -..��................. Distance to nearest: Weil ._./�.�.:�...:.............. ..Foundation ..e �.. ........ Prop. Line ...:5. 4....-.--. LEACHING LINE [ No. of Lines ....` ................. Length of each, line.../...0.�............... Total Length Joa................ 'D Sox " �'.. Type Filter Material ......Depth Filter Material ...1.9.............................. Distance to nearesh Well ....lAe."-f.. Foundation .Q.�. ............ Property Line A.-*A............ EPA PI Depth Diameter ................ Number ............................ Rock Filled Yes Q No (] SEEPAGE T [ } D p ..... .� WaterTable Depth ................................................Rock Size ................................. rl Distance to nearests Well ........................................Foundation .................... Prop. Line ...................... I REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank [Specify Requirements) ......................................... . ......................»..........................................._................ Disposal Field (Specify Requirements) ................................................:''.................................................................................. . . .........................................................................>. ....................-........................................................................I........................ r ............................-.......................................................... .................I.......................................................................... w (Draw existing and required addition on reverse side) R 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. Hone owner or licsn- sed agents'signature certifies the following: "I certify that In the performance of the work for which this permit Is Issued,_ shall not employ any person In such manner as to become subject to Workman's Compensation wsta lfornia.[ P .,Signed .....i . !'�?- .... ....... .. wner By ..... ................................................................................................. 3itle .......................:................................................ (If other than owned FOR DEPARTMENT USE ONLY oL..�rQ._.:. .......: APPLICATION ACCEPTED BY ... . ... .. . ........... ... ................................................................. DATE .1..:. BUILDING PERMIT ISSUED .............................................................DATE=-: ........................................ IADDITIONAL COMMENTS .............................................----------.- ---..........----........................------....-....-... ................. r _.. .. .. .••................................... ...... ....... ........ ................--.......--.... . .... ........ Finol Inspection by: ...... ,'. `.:..................-.................................. ...--.................Date .. .'L.4-.... EH 13 24 1-66 Rev. 5l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M ii