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i q FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................... (Complete in Triplicate) Permit No. ..7 .. 3.. ,,,,,,,,,,,,,,,,•,.,,,,-- .-------.----- .- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein y described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: j77S7 JOB AQDRESS/LOC I N �. _-••- ...............CENSUS TRACT ............ ...... Owner's Name .. Phone, ` Address ----- .. 40.. _ .......................... city .....•.................................• ........ Contractor's Name . - :.. _... . - ...........:....License #r�7 S �'. Phone,:!9t4msf . . Installation will serve: Residence 1314portment House❑ Commercial ❑Trailer Court f3 ' Motel [3 Other ..........--_-_--------•___•--•-••• // � .. t Number of living units:.....:_. Number of bedrooms ......Garbage Grind .._ a er. t SizeJk$06 -6 Water Supply: Public System and name .............. I ] Private [ -.... - Character of soil to a depth of 3 feet: Sand E"Silt E] Cloyp❑ Peat❑ Sandy Loam ❑ Clay loam ❑ �. r„Hdreipan"❑ kdobe❑ `Fill Material ............"if yes,type •-- .................---•-• : (Plot plan, showing size of lot, location of. system in ,relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet,) i PACKAGE TREATMENT SEPTIC TANK Size.t. ..._. ( ] � ] �,�..,� . ------------------- Liquid Depth ............ � capacity �i? C ._. TypefLe .rte° .? Materipi___ .� � No. Compartments ...................... • /.— .04Distance to nearest: Well -- r ........Foundation _.1.1V.......__.. Prop. LEACHING LINE ( ] No. of Lines .. Length of each line._ Total Length _. ........_. D' Boxy, :... Type Filter Material r�jCeDepth Filter Material __. ...... ................�. 00, - Distance to nearest: Wellr . ,—=-Foundation // l ------•..._. Property Line l��.. ........... . Z .. SEEPAGE PIT [ ) Depth -� ._... Diameter ............:S_. Number ............................ Rock Filled Yes ❑ No C3 ' Y Water Table Depth................ .. .. si......,_......_Rock S_ ize Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -.:.__ ....._._..k._ ____.: _: .-Date ............................. Septic Tank (Specify Requirements) .................... :.._....... ......... N 21 3 Disposal Field (Specify Requirements) --------- ....--.......-------------------------•---•-••-----------------._.... ...................................... ._._..., -0 -------------------------------------------------------- --------------------------------------- ------ - -_-------.------•------------ -- -_------- ---- ------------- •----------------------- ---------------------=------- -------- (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 Sar! Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- rsed 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 becm subject to Workma ' C pe atlon laws of California." Signed .��L�!? -2 - -- . - . ................................. Owner BY --------------____.................................. ..........................................- i tle .---------............................. .............................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........... .. .:................................... ...............•.............................I DATE ...... ._17...7s ...... BUILDING PERMIT ISSUED •- .....................................................DATE ........................................... ADDITIONAL COMMENTS ......................................................... -.................................................................- .....----•----- ._..--•.._........ ..........................................................._....................-...................................... ................................ ................... ..............:.......................-.......................................................... ....................... - -----•..._. Final Inspection by. ��--•......................................•--••-----._.....................-•---------Date ..-•-•� ---._..... .. SAN JOAQUIN LOCAL HEALTH DISTRICT r. 14 13 24 1.'6A Rev. 5M 7/72 3 M