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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 7s. i,5z Permit No. -'------------------- lComplete In Triplicate) -••_-••..........................................___.__ This Permit Expires 1 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ................—.- ---•-•-----------._........_.................. ................CENSUS TRACT .......................,..... Owner's Name _ .6 . �'lri._. a ..................Phone .... . Address . ` ........�-- ---- --------- -"�-�---�'� -�'?---��--...........---... city ...... •r....,..1? ,.,�..................._....._ Contractor's Name � .......--------------------------------------------License # ........................ Phone ...._............. ...... ------------- -------- -------- Installation will serve: Residence❑Apartment House f] Commercial❑Troller Cvm1 Number of living units:_.��...... Number of ❑Other...Motel . g bedrooms ............Garbage Grinder ............ Lot Size ............WS-6.,O!, ........ Water Supply: Public System and name ------ ............................_.........................................................................Private ID Charocter of soil too depth of 3 feet: Sand[g Sift o Clay ❑ Peot❑ Sandy Loam {'1 Clay Loam ❑ Hardpan Q 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 public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK f ] Size................................................ Liquid Depth .......................... Capacity -------------------- Type .................... Material............... No. Compartments ...................... ) Distance to nearest: Well ...................Foundation ...................... Prop. Line ------------------ .--po LEACHING LINE [ ] No. of Lines ......./------------- Length of each line...-_-3 . .... Total Length ..../7 ................ 'D' Box .--/...... Type .Filter Material _.f .` Septh Filter Material .....-!? ...........................04 Distance to nearest: Well Foundation Property Line ........................ SEEPAGE PIT { ) Depth -------------------- Diameter ..... .......... Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ................-.............. Distance to nearest: Well .Foundation . Prop. Line G REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------------- Date ......... ........................ Septic Tank (Specify Requirements' • c Disposal Field (Specify Requirements) --- ---- -- ---- - - - -------- Draw ---••-Draw existing and required addition on reverse side) 1 hereby certify that ! 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. HoMa owner or licen- sed agents signature certifies the Following: "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such manner as to become subject to Workman's Camensation laws of California." Signed. -- ------- Owner BY - -- -- --- -- - - ----------------------------- Title ..... ........ - (If other than owner) FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED SY ----- ---- - -- -------------- ------------------------ ---------- ,-------------------....------ DATE ------------- ... BUILDINGPERMIT ISSUE=D ----- ---- -•---- ------------------------------•------------------------------ --------......DATE . -------------•------•-...--......_....... ADDITIONAL_ COMMENTS ----------- ......................... -------------------------•- ------- •---- ----------•-- ----------------.------------------------•----------------..._...----------------------------------------.............. ------- _..... •------------------------------------- ---- --- -) , - Final Inspection by: .. ------ -------- --------------- _Date -- - ... EH 13 21; 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71; 3M V