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FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . '-?d� " .......... This Permit 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/LOCATION .....J.[ . " , � CENSUS TRACT ........Owner's Name , , ............•-•--• Address ,._.._;__.._..._. ................... City..... �1r Contractor's Name ....License # . . . Phone "T . 3"� Installation will serve: Residence W Apartment House 0 YCommerciol '[DTrailer Court 0 Motel ❑Other ...................... ..... . .. 70 P S i NumWateber of hiving unit System Number of bedroom ---`3-----Garbage Grinder __.::.------ Lot Size ...................... PY• y and name ..._ ---- - ..............Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay j] ' Peat j] Sandy Loam C] Cloy 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.) k NEW INSTALLATION: INo septic tank or seepage pit permitted if ublic sewer i�available within 200 feet,) � e. 9 PACKAGE TREATMENT [ I SEPTIC TANK ry Size--- !/.�S Aa 9 ' ....................... Liquid Depth ......��_.r:"Z...... : Capacity�`, .Q.Q..•"• Type -, f— ,'Material No. Compartments i .. ...... Distance to nearest: Well ..__J,r�c?.�` ,f - pro Line . .. .................Foundation .. .!�':_--•_-• p• �,�....:. + LEAC RING LINE [ ] No. of Lines-,.....__. --- ---------- Length ofeach line-----.-O� T..._._: Total Length ....-00.`-:._-_.._. 6 D' Box .__L^" Type Filter Materia# -••--- filter Material � s Distance to nearest: Well . 42q . Foundatifn -- Property Line ..•"•• SEEPAGE PIT . Diameter f Depth . ._ ._.-•----- � Number .._._... -.••-•-•----... � p Rock Yss�` No [] Water Table Depth -------_.."___.... Rock Size ._ f —z --- •-... 2......--- Distance to nearest: Well .------,iso-- -----,....Foundation _ IOQ- .. Prop. Line .�Zr__-:- � 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. Hoene 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 B ...................................... ........the _ ner).----... .................`-----•• Title ...._ . • - _._...Lr.'. � � (!f other than owner} •'•'"�""""""---' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y__.. f - .- ------•--------------- ---...... DA .•-.-- ... .... W7/- DA •BUILDING PERMIT' ISSUED .._ _ .. .. _ .ADDITIONAL •. - __.....-- MENT5 = ---••... ........... TE`.. .. . ,._.... ...................•-_...._ ...--- .......... ...... ----------------------I--........__ ............................ -•--•-.... ......... ----• ---- r. Final Inspection by: ------ -•.... ......................:......D .t-- ��...� �_._.. JOAQUIN L HEALTH DISTRICT E. H.13 24 1-'68 Rev.5M - •--