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'PLICATION FOR 'SANITATION 'PER'� ' � t (Complete in Triplicate) - Permit No. 7�,.............` ......................... This Permit Expires 1 Year From Date Issued Date Issued ._3JWe! '7e/ 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.`544 and existing Rules and Regulations: JOB ADDRESS/LOCAT O ••. /- ... ENSUS TRACT .......... Owner's Name ......Phone � c7 Address .........-- T- . City ..... ... ....... ....... Contractor's Name ... t. !_-.� License # � - PhoneZ: Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court l] Motel ❑Other . •--••.....:..:.....•--• Number of living units_____________ Number of bedrooms ............Garbage Grinder ............ Lot Size `.......... Water Supply: Public System and name .................... ..................._.....................................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0-- Hardpan ❑ Adobe:❑ Fill Material ............ If yes,type ---------------------- (Piot 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 I ] Size------------------------------------------- ---- Liquid Depth .......................... Capacity .................... Type ..... Material................. No. Compartments .................... Distance to nearest: Well ........A -.._•_•Foundation ... Prop. Line x .. Len th o each line-------------------_------- gth LEACHWG LINE [ ] No. of Lines ..................... gTotal Len ............................ O 'D' Box . Type Filter Material ....................Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line .:......:......... :..._:9 SEEPAGE PIT [ ] Depth -------------- Diameter ................ Number ---------•-•--:-.---._---- Rock Filled Yes ❑ No ❑-r Water Table Depth .........Rock Size Distance to nearest: Well ........................................Foundation ............4....... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................----_-----------I 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 San Joaquin Local health District, home owner or lien• . sed agents signature certifies the fallowing: "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 Compensation laws of California." Signed ........ Wotiher Owner --------------•------- .... - By . . . . - ---------------•---------- -----• itle ----- -- than ner) FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY .. •--•----• ...... ......................................................... DATE .....S ---•- BUILDING PERMIT ISSUED -- ---- -----------------------------------------•-•--------•----•--------:...__._.._._.._,.......----...DATE ..................-........................ ADDITIONAL COMMENTS -•------------------ .............................. .......:...--.................................................................................................................. .............. ................................. •... . ... ..... ------....---------•----.............•-•-• --------- FinalInspection by: .. --_.._ . .............................,................... ........ ------ ......................Date ......... _ .......... SAN JOAQUIN -LOCAL:HEALTH DISTRICT F N 13 24 1.-Aft u,,,, 7/723 M