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APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires Year From Dote Issued <br />Permit No. <br />Date Issued <br />FOR OFFICE USE: <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct arJ install the work herein <br />described. This application is mode in compliance with Count Ordinance Jo, 549 and existing Rules and Regulations: <br />g JOB ADDRESS/LOCA,TN / 3 3A.t/p <br />Owner's NameA412,e-I-44-- <br />Address ,„„7/ Aj4-1' City 6.-4-7-e---1 <br />Contractor's Name .... ........ 414.. License #/..n <br />Installation will serve: Residence partment House .0 Commercial 0Trailer Court tJ <br />Number of living units. Number of bedrooms 4 Garbage Grinder <br />Water Supply: Public System and name <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Cloy 0 Peat 0 Sandy Loam <br />Motel 0 Other <br />Lot Size <br />Clay Loam 0 <br /> Private <br />Adobe 0 Fill Waterial If yes, type Hardpan 0 <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT ( ) SEPTIC TANK { ) Size Liquid Depth <br />Capacity Type Material No. Cc mpartments <br />_ <br />Distance to nearest: Well Foundation Prop. Line <br />i'd <br />.Totdl Length <br /> <br />of each line ‘.0 <br /> Depth Filter Material 00 <br />V P perty Line <br />Rock Filled Yes 0 No 0 2. <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Dbstrict. Home owner or licen- <br />sed agents signature certifies the following: <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ arty person in such manner <br />as to become sublect to Workman's Compensation laws of California." <br />CENSUS TRACT <br />Phone <br />3 Phone <br />LEACHING LINE ( No. of Lines Length <br />Box Type Filter Material <br />Distance to nearest: Well Foundation <br />SEEPAGE PIT ( Depth Diameter Number <br />Water Table Depth Rock Size <br />Distance to nearest: Well Foundation <br />REPAIR/ADDITION (Prey. Sanitation Permit # Date <br />Septic Tank (Specify Requirements) <br />Disposal Field (Specify Requirem ts) ?elosl <br />P710 <br /> Owner <br />Iitle <br />Signed <br />By <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY.. DA _ 7 <br />BUILDING PERMIT ISSUED DATE <br />ADDITIONAL COMMENTS <br />(If other than owner) <br />Final Inspection by......... 1:..4k2k--1„,../2..tfet46 Date - -7 <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />7/723 <br />E. H. 13 24 1-68 Rev. 5M