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mm urriii-c ubcs APPLICATION FOR SANITATION PERMIT ...... ...........•................................. Permit No. ..7. ...�� (Complete In Triplicate) r --.. .--.....---.................................... ��-�•-'�- ... This Permit Expires 1 Year From Date issued Date hued ..c��.._ ... �" 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 compli ce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/I.00ATIO CENSUS TRACT .......................... P Owner's Noma ... ..-�.. .. ......i.............................................. ..Phone .1..��. � � ........ <idclress .............. J•-. !d_.... 7.. .............City . E ........................................... Contractor's Name ................... .- .. U`'' License#,f:X77:A?.'Phone aje installation will serve, Residence 4Apartment House C] Commercial❑Traller Court 0 Motel ❑Other Number of living units:.....L.._ Number of bedrooms .....3._Garbage Grinder ............ Lot Size ... . , ...........Qjr Water Supply: Public System and name ............. --------------------- -.-.-----•--.-.-•---.......--................................•---......Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe Fi11 Material ............ If yes,type ............... ............ !Plot plan, showing size of lot, location of system In.relation to wells, buildings, etc. must be placed an reverts side. NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT f] SEPTIC TANK -Size.... ..K..1 :...................... Liquid Depth ....... ............ Copacity,1_c?4*...... Type .. ........ . ..: Material._......:..... - No. Compartments .... :�......... Distance to nearest: Well ��J?. _,.1.........Foundation ... . Prop. tine _ ............. TEACHING LINE No. of lines .- .....` ...... length of ch ............. Total Length .... '- 'D' Sox ...: Type filter Materia! ... ... ........:...Depth Filter Material:-.-..... ..................... ....... Distance to nearest. Well ... ..... Foundation . . `" Property Line ...1 0 SEEPAGE SIT I Depth .....� .r..... Diameter ..�,15..��... Number....._..... . ...... R k Filled Yes ....No... ;r .. Water Table Depth ........................... Rock 53zs .!.. - ...... .Distance to nearest: Well ........ ,6.....t:....... ....Foundation ...� .... �... Prop. Line .. ...�... REPA10ADDITION(Prev. Sanitation Permit# ............................................ Date ................................ .1 SepticTank ISpecify 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 Ilam sed agents signature certifies the fallowing: "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." :.knee .......... ........... ........ ......... ... Owner By ..... ............. .. .............. 3 - title......- ........................................ :. (if of er #� owner! `' . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....._. DATE . ......... ............... BUILDING PERMIT ISSUED .................9. ADDITIONALCOMMENTS ................................... ---•-----•--.._ ....................._........................._._........ ..._.....---........ . ............... ... ........ ,�.. _....( ..�._._. aG........ / ._. "- —.'._.... - ................ ......... .. .U... . .-... Fina! Inspection b .. ... . �^-................. ..........•-• . --.-.........Date ........ .. y.. P y: ... M 13 2h 1-68 Nov. 5m SAN JO UIN LOCAL HEALTH DISTRICT 8/7)i 3M L 7 5'- 5�� 04 v