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FOR OFFICE Use: APPLICATION FOR SANITATION PERMIT S� � .............. ._. ........__ .,-----------..._...... ,, ti Permit No. 7S •� (Complete in Triplicate) ...... ............................................ Date Issued /� 7.........7 5 ......................................................... Thls Permit Expires 1 Year From 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 i de in compliance with County Ordinance No. 549 a d existing Rules and guI tions 63 JOB ADDRESS/LOG ATIO ...... .............• C S TRACT ...._.. 6 --3�� . Owner's Name .......... ... ....... . A..-- -- .... .........................................:.......... .........Phone. .._. ........ '. Address ��1.f�7...... �/�d - --••--..... City �.................••--. ..... .................... _......_.. Contractor's Name QZ.c�...................License # j Phone Installation will serve: Residence Apartment House Commercial❑Trailer Court ❑ Motel ❑Other .............•• -••---•---......_......--- Number of living units:......_.(.... Number of bedrooms .......Garbage Grinder ............. Lot Size ....... ..�� ........... Water Supply: Public System and name .................................................................................•-•-...... .............Prlvat!A Character of soil to a depth of 3 feet: Sand F] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ 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 pubic sewer is available within 200 feet) <� PACKAGE TREATMENT { ] SEPTIC TANK Size-- ....I......................... Liquid Depth .. .._....,..... - Capacityl-,-t:,90--•---_-- Type ... ....... .. ..... MaterialNo. Compartments ..... ....... Distance to nearest: Well ....... ...............Foundation .......1_.S?......... Prop. tine ...................... O e F LEACHING LINE , No. of Lines .......Y--------- Length of each line------ ... . . Total Length .... .............. u► 'D' Box ......`� ..Type Filter Material .. ---Depth,Fi er Material ........... c .....::.................. Distance o nearest: Well ...- ... ... .. Foundation '--/�---.........Property Line ...fir.r?�............ rz SEEPAGE PIT Depth ... 5 ..__. -! Diameter _.�_�?..�.�... Number ........?�:7---:..._.--:"Rock-Pilled Yes � Na Water T epth ...................... • -•--••••....Rock Size3-�•---X.t1.....----- y1 ` Distance to nearest: Weil ........��.....-.r.............Foundation ....f I.P. �...... Prop. Line .........r........... • REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date .................................. SepticTank (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 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 --------------------------•--------------•----- ------...a . Owner BY ....--• •-------•............ .�than ...... - Title --•------------- ........--------•---••-••-•••-•.....--- (If other w r FO EPARTMENT USI: ONLY APPLICATION ACCEPTED BY .. ..................... -....... DATE . ./... .,7................ BUILDING PERMIT ISSUED -...._.... ..----...._ .....::..........DATE ..._...._.. ...................... ADDITIONAL COMMENTS -------- - - -..__ '- .............�--_ I !`_ -..� ................................... .....--- '_ - 'r- ------------ ------------------------ ------------ .....I.......................... ............................................. ...... ----- .......•......... ............... Final Inspection b ............... _ ........Date ..../.. ...-,rte :.. .._ SAN JOAQ LOCAL HEALTH DISTRICT F-14-13 24 i_,,Aa n.... =•• _