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p FOR OFFICE USE: - �1 APPLICATION FOR SANITATION PERMIT _ (Complete in Triplicate) Permit No. .. ............... This Permit Expires_), Year From Date issued Date Issued : 4�zz� Application is hereby made to the San Joaquin focal Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: i ' � J� . JOB ADDRESS/LOCATION eo 3' Jam" ! .� . �.`�/ 'U ......_ Owner's .Name ..........._ t`�' a �.. �. ......CENSUS TRACT ....... __.......... ,.. Address ._.._.... Phone ...._ ` Contractor's Name ....-------•-• .............................................................................................License # ._....---.---.._.....:.. Phone ..........I._.. Installation will serve: Residence �A artment•House 0 Commercial j]Trailer-Court � . l Motel ❑Other ........ .-----•--••--,--- Number of living units-------...... Number of bedro ms ---�5 --- Garbage Grinder ....... Lot Size ..._._ .................... I Water Supply: Public System and name ............ --------•----.....................•---•-------•---------_- ----P ❑ Cla Private Character of�soif to a depth of 3 feet: Sand ❑_ y Q.�,Peat �] :::Silt_ El . Sandy Loam ❑ Clay loam Hardpan [] Adobe'0 Fill Material .......:r... Ifes Y ,type .................. . (Piot plan, showing size of sot, location of. system' in relation to wells, Y buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted ifpublic seWer is available within 200 feet,) PACKAGE TREATMENT SEPTI TAN K i ] Siae A � / .... ` '------ Liquid Depth -•-- Capacity ........ TypeA=.dd.' Material._ _ Na. Compartments Distance to nearest: Well �• Foundation ..�� ....r__. Prop' Line-•-- • LEACHING LINE � No. of Lines .. '3 • ••_ . ._._...- Length of each line._._._...-. ------: Total Length ---/_..Z� ,�.=-_ . : -.. D' Box ..____..__.. Type Filter Material-� f •�gc�epepth Filter Material ._...._r `` Distance to,nearest: Well ......140_ __--:-_ Foundation ' Prope Line -- --- p � . SEEPAGE PIT •--••••- C Depth ----- .-�_.. Diameter Number ..-_ ..--_ Rock Filled Yes No >D � Water Table Depth ....... -------Rock Size Distance to nearest: Well ......---.__P! ....Foundation _�V. -. Prop. Lire �-- REPAIR ADDITION(Prev. Sanitation Permit# ---------- .............. Date 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 licen- sed agents signature certifies the following: "I certify t in the perf once of the work for which this permit Is issued, I shall not employ any person in such manner as to bec a subject W ri`�nan's Compensation laws of California." Signe . ..... .. -- CLl11/ --••-------•-• .............................. . Owner B ........................-------------------------- (If other than owner) ............................... Title _..---••...................... FR DEPARTMENT USE ONLY APPLICATION ACCEDA E PTED BY ..............r.-----.. .-•---_ BUILDING PERMIT ISSUED _. = DATE ...�...� 7 ...... ADDITIONAL COMMENTS :.-----.•--.. •-•• �. . ........................... TE MAT ...........:....._..... . ................-........................................ �. •,f . ................• � '. ......................... ;-}t. ..... ................................................... .._..._.....------• ...........................................• .• W. - .........._._......._.._..-----__._.._._................ ..................................._..__._ ••.-.•• r _...._...___..._.....__.- Final Inspection by ` :....... p _ ate „SAN JOAQUIN LOCAL. HEALTH DISTRICT d � �., _ ...E .. E. H.13 24 _ —_ —. I-'68 Rev. SM