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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- Permit No. -71- 3S (Complete In Triplicates ..................................................... Date Issued This Permit Expires ] 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 is made in compliance wit ?County Ordinance o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N .......�./.�. ' _._.. f f... ._, T. ,..... CENSUS TRACT Owner's Name . �5-fsl� 1� --.... ...........................Phone .............. _ Address .a.. '._.. ..., _..._ .y_ ._ �,y........................ City .......................-.-......... Contractor's Name ... 4 �• � ...............................License #' a.7/,1�. ... Phone ... �j�6 ..' Installation will serve: Residence artment House Commercial OTrailer Court El Motel0 Other_................•-•-----------............. Number of living units:........ Number of bedrooms 2.....--Garbage Grinde .... Lot Size ............... Water Supply: Public System and name -7------------ ........................................................................................Private Character of soil to a depth of 3 feet: Sand L] Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan ❑ Adobe E3--Fn Material /4,40 If yes,type ............... ............ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide.)— NEW INSTALLATION: (No septic tank or seepage It permitted If public sewer is available within 200 feet,) / tn� SEPTIC TANK Size.-.17 .... J_._---- ��.... PACKAGE TREATMENT [ ] �/ ..........._. Liquid Depth .�.................. t,�} Capacity --.•-- Type .-__-)&4 Material--- ---- ---------- No. Compartments .12... Distance. to nearest: Well --.---.. - -------------- ---Foundation --w-`-......... Prop. Line-s ............... LEACHING EINE ( of Lines }-- �.- '- 'Length of each line._61�___- '�fotal Length ,/........................ 'D' Box Type Filter Material . ... 4� -- Depth .Filter Material ..... ..p ........................... Distance to nearest: Well _.__ ......... Foundation Property Line .-S,. ............ • �� ............. Rock Filled Yes El—No 0 SEEPAGE PIT �}� Depth ..�-�-..-_-- 3�iameter ..�3____-- Number ------�. .. Water Table Depth ...._. /._'7/�.........................Rock Size --.-/.1z,t ,�,_.._.._.. Distance to nearest: Well ------/649 ��G.�_...-.Foundation ._....�..�./. Prop. Lina - ......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..............................._..) SepticTank (Specify Requirements) .......... ...•--•----.----•------•---------------------- ................--......-----......................I...................... 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...... • Owner By ----- ------- --• . ��---------- -------- Title (l�r than owner) - FO.R.,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - ----••-- --- - --- ---------------------------- DATE ........ ...G -.` ...---------•--- BUILDING PERMIT ISSUED --------------------------------------- --------------DATE ........-...................... ADDITIONALCOMMENTS ..................I....... ----- ... ------------------------------------------------..................................... ---------•-----------------------------•----------------------------------...---....-----•---------.._._.......-----•-..__..-...-- ........ ...................-------------------------------------- ...... Final Inspection b -----Date - -- .......... EH 13 .21 1-613 . SAN JOA UIN LOCAL HEALTH DISTRICT 8/74 3M