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FOR OFFICE user: APPLICATION FOR SANITATION PERMIT . ......................................... N. (Complete in Triplicate) PerNo. ..7` -.....3-. .......... This Permit Expires } Year From Date Issued bate 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION . .................CENSUS TRACT Owner's Name ...........: . y� ...... ...... ... Phone ................. Address /.:�Ila- .. .. ..l..... .................City .......................................I.......I...... Contractor's Name . -''------ '& 1--.-.1.......License # -17cs 'shone Installation will serve: Residence 92"Apartment House❑ Commercial OTrailer Court 4 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❑ Silt❑ Clay ❑ - Peat❑ Sandy Loomj(K Clay Loam D Hardpan ❑ Adobe Q 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 [ j SEPTIC TANK t Size._ -- P�_ Liquid Depth .�1.... :..... ..... a Capacity 16,*4o.:..... Type( Material No. Compartments ...: ...... fo Distance to nearest: Well --------_._. D..................Foundation ...../.p............ Prop. Line ...5 �,r. ............... LEACHING LINE (1►� No. of lines .... ......... Length of each line.------- ......... Total Length .... d.a...`............ 'D' Box -----C----- Type Filter Material .:.-5.)Z....Depth Filter Material .....�'f................................. Distance to nearest: Well .......... Foundation ...... 92............. Property Line .::9:................. SEEPAGE PIT [ ) Depth Diameter ................ Number Rock Filled Yes ❑ No Water Table Depth .............Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ...........-.-.................. .-.) Septic Tank (Specify Requirements) -------------------------------------- -----•---•- ----------------•........................................................ Disposal Field (Specify Requirements) --•-•----•--••-----••---•--- -------------- ----------------- --------......-------.......--............................--•....... ---- .f.................................................. ---•----------------- ----------------•-----..... ---------- •---------------------•--•--•----------- •• �.. --•----------------•--•--•---------------------.------------------------------------------- -----. . _(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 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." Signed ......... -------------••-.-_ Owner -&................. Title _ a u"............................................ (if other thonLowner) s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE .....1 —..1 ..? ....._. ....-•---••------------------=-----••----....------.........•---••--•--•---•.. BUILDING PERMIT ISSUED .................................................................. :..........................................DATE ............:.............................. ADDITIONAL COMMENTS ` __-__ .......................•..•-----...•••----••--------------------•-----•---•------•-..---------.--.......-•----...............--•---...-------------------•--•---..._---•--. --_... ....................... ....................... - ......_.._.....---...-----.....--------._.....................I...................... ._...- .... ----' .... Final Inspection by; � .':............... .-••--••••.......••..................Date ......eZ. ..1 ..,7 ...._... .. SAN JOAQUIN LOCAL HEALTH DISTRICT _ 4 \-104 E_ H-13 241.'68 Rev_ SM T 7/72 3 M ✓ 1