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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - ° 5 (Complete in Triplicate) Date Issued - 17- 72' This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct"Zi`nd install the work herein described. this application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO Airf..2e; ....... . CENSUS TRACT Owner's Name Phone Address • Contractor's Name / !:,' Residence c'Apartment House° Commercial 01Trailer Court 0 V Motel 0 Other Number of living units: i Number of bedrooms 2--- Garbage' Grinder Lot Slize- Water Supply: Public System and name A., . ‘ Private fir Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam .rif Clay Loam 0 .. Hardpan 0 Adobe 0 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 26R,feet,) PACKAGE TREATMENT [ 3 SEPTIC TANK I I Size 4 Liquid Depth 'Capacity Type Material No. Compartm \ents . Distance to nearest: Well Foundation Prop. line .._. ........... . . ..... LEACHING LINE [ 3 No. of Lines Length of each line Total Length 'D' Box Type Filter Material Depth Filter Material Distance to nearest: Well Foundation Property Line SEEPAGE PIT [1 Depth Diameter Number Rock Filled Yes 0 No 0 Water Table Depth Rock Size Distance to nearest: Well Foundation Prop. Line REPAIR/ADDITION (Prey. Sanitation Permit if. Date- A.) Y JP--/ (Draw existing and required addition on reve e 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 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 subject to Workman's Compensation laws of California." Owner i • (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - t Final Inspection by: Date SAN JOAQUIN LOCAL HEALTH DISTRICT F 14 0 1 - AR Rev. 5M - , e oie.,e2;4,:xd•J1L isf:--1•,.:-ellicense #1,11 3,17,-Phone City Installation will serve: Septic Tank (Specify Requirements) Dispoçal Field (Specify Requirements) I Signed By BUILDING PERMIT ISSUED ADDITIONAL COMMENTS DATE DATE