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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .............. - Permit No. (Complete in Triplicate) ................ This Parr"It Expires 1 Year From Date Issued Date 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. 549 and existing Rules and Regulations. JOB ADDRESS/LOC TION .�. -..... ... ." !. S ... ... ......... ...........................CENSUS TRACT .............. Owner's Name ......................................................... ... Phone .. .. ...... AddreAddress ../.$0.---------. ..... . .... City ..� �°. ... I...................... ss . r � Contractor's Name ---..... . ... ...............License # ,�� '� .. Phone ......................... Installation will serve: ResidenceCEI'Apartment House Commerclal ❑Trailer Court 0 Motel ❑Other iNumber of living,units:...- -- Nurnber of`bedrooms ..-:',—Garbo a Grinder ............ Lot Size Water Supply: Public System and name .......:......_ ------------------------------------------............................ ...-•....................Private Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Cla �❑- ,Peat❑ Sandy Loam 0 Clay Loam o Adobe Fill-Material :`: "`..'..`lf•yes;type............... Hardpan �.] ............ (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 see age pit .permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK ' i Size.Za.-. _.q.....X ..........".. Liquid Depth ...�................. k ' Capacity J_k�m!?_ OType �,-..... Material....- r--.. No. Compartments .._�,...... VQ Distance, to nearest: Well -----.----a0.1-i............Found �. ----- Prop. L . anon ..". S` LEACHING LINE [ j " No. of Lines ..----v ---- Length of each line...... So".Fci.......... Total Length ----I_.€-,P..k.-T..•---- 'D' Box "-.. Type Filter Material ......,5-q.......Depth .Filter Material ....JA..........a-- -. ................. Distance�to nearest: ,Well ......:_.SQ. :--;'Foundation "--.-.". !?. ... Property Line ........... SEEPAGE PIT ( Depth- --------".-`- Diameter �'3 �r ... Number :..-'.";;�k--._...:. -... Rock'Filldd—'Yes 0---No Water Table Depth .............I-gib. ! 3 u � C ---•--•-------------Rock Size -_J: . JC,........._.. Distance to nearest: Well ..........LPt 4?..k...............Foundation ..-_ ._�"- -- Prop. Line -----5". . REPAIR/ADDITION(Prev. Sanitation Permit a# --------------------- --- ......... Date :-_----- ....) Septic'Tank"(Specify Requirements) ...................r_.............. .,-.-......-•- Disposal Field (Spegify Requirements) ................... ------------------------------------------------I—— - ......... ....... :..- {Draw existing and required addition on reverse side)" I hereby certify that 1 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 ragents signature certifies the following: 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 fBY ; - ..".......... = ----------------9--------- ---------------- Title - -"....._ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._...�. .. �� BUILDING PERMIT ISSUED -:. ------ DATE -----DATE ... ...................... ADDITIONAL COMMENTS ...-------._.-.-....---------." -----------"------------- --------- --------•------------- .------ ... final Inspection b - - p Y = ....... ---•-•------•.......................................................__Date ....�./fQ� " EH 13 2!� 1-6(3 Rev', 5M - '7 ......-•-- ..a SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M