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FOR OFFICE USE: i APPLICATION FOR -SANITATION IT ............. ......��.................. ... 7.�:�O? (Complete in Tripllca �� P it No. ..................... .............�,,'1111.._..._ 1111 ................ ,,// 7 ........................................................ This Permit Expires 1 Year From Data I ad 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 ADDRESS/LOCATi N �. ... .... t�. ... ..... -.-.:....... _...........CENSUS TRACT b�.....7.-.-•--•Z-... .�0......... ... Owner's Name 1111... ...... P,ane� Q' City__ _ ........Address ....... S . . ... ._ Contractor's Name ........... ........ .. 11 1 1. 5 ? ........................license## - `f:. c} .... Phone Installation will serve: ResidenceX Apartment House❑ Comtnercia)OTrailer Court ❑ Motel ❑Other............................................ Number of living units:......... Number of bedrooms ....?'._....Garbage Grinder ............ Lot Size ."......."Y....... Water Supply: Public System and name .........................................................._...................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam Hardpan❑ Adobe❑ Fill Material ............If yes,type............................ ......mss (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on revorso side.) PIEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK 4 ] Size................................................ Liquid Depth .......................... /1,Cdpacity .................... Type .................... Material...................... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE No. of Lines ........................ Length of each line...................111.1111. Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to Nearest: Well ........................ Foundation ................... Property Line ........................ SEEPAGE PIT Depth Diameter ................. Number ........... .."~111:1 Rock Filled Yes ❑ No ❑ Water Table Depth Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... IiSPAIII/ADDITION(Prov. Sanitation Permit tr ............................................ Date .................................. Septic Tank (Specify Requirements) .....1...........111 :..... .........................................--------.-..._..........11.11...-...._........._....... Disposal Field (Specify Requirements) .--- -.... .�. �........--- -•••--••••-•--•••••-•--••• --... -•- .................•--••••-•-• •---- �1 uS�....�Z�-St►-� .. . ....._ .....--- 1111 1111 -� - •,�- --•--•.......................1111.-1.111. •..................•----.......-••-•................... .......-•-------•--------._......--------.....-•-----•--•-..........---...................._.............._.........•--...........--- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will bo done in accerdanco with San Joaquin County Ordinances, State Laws, and Rules and ltogulations of tho Son Joaquin Local Hoalth District. Homo owncr or licon. sod agents signature cortifios tho following: "I certify that in tho performance of tho work for which this permit is Isseod, I shall not cmplaq any portion in suds manner as to bocomo subiod to Workman's Compensation laws of California. Signed ....... ....... .. .....I... ... --.........................-••-•----� ii or By...__. '... . 71tie ..._..._....��..`................................................ (If other n ow r [3 EP ME USE NLY APPLICATION ACCEPTED 8Y.(, -..._. .....1111 -- --._.... 1111_. DATE ...%/ :14-72X................. BUILDING PERMIT ISSUED ...... .......................DATE ........................................... ADDITIONALCOMMENTS ...............................................................—............................................................... :......_........... ......................................-----.. 1.111. ........... ...._........_...................... 1111... ...... _."........................ .................................................................................. ........._........ - 1111 .-... .. ............. ... ..... 1111... .............. j Final Inspection by: Date 1 .,��.............. SAN JOAQU LOCAL HEALTH DISTRICT E. H.13 241-'68 Rov. SM A-1/72 3.H