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rvR %irril,G uaL: APPLICATION FOR SANITATION PERMIT 7 Permit Na/.s......�r� ....................... ............... lComplete In Tripticalel .........................•......_..---•••._....... Date Issued .-./._l....%S This Permit Expiros i Year Freie Dat* 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. 519 and existing Rules and Regulationsx JOB ADDRESSIIOCt/140 _ _•..........................CENSUS TIt,4Ct' ....-.-...........•......_ Owner's Name ...........Phone ........... ............. .......... Address_.. I �........ .. ..--_..... City _..................................................._ ... .... !.. o .License # �}O,y^.. Phone ................. Contractor's Name ��,.. Installation will serve: Residence Apartment House[] Commercial ❑Trailer Court 0 Motel[] Other ............................................ Number of living units: J. Number of bedrooms r.� Garbage Grinder ......... Lot Saxe ................ ............ ...........:.... Water Supply: Public System and name Private [ll. Character of soil to a depth of 3 feet: Sand 0 Silt ❑ Clay ❑' Peat ❑ Sandy Loom Clay Loam [3Hardpan ❑ Adobe ❑ Fill Material -----.------ If yes, type ........................... (Plot plan, showing size of lot, locatlon of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit -.permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 1 ] Size ........:...............:... Liquid Depth ..__......._.............,. � ................. 6 CapacityType MaWlal..... .............._ No. Compartments .....................;. Distance to nearest: Welf...fovndation '...................... Prop, tine ........ .............� ' LEACHING LINE [ ] No. of lines ' ....._......• 'Length of each, Ilne..'.....__-. ...... Total Length 'D' Box ............ Type Filter Material -.Depth Filter Material Distance to nearest: Well ........................ foundation .................... Property tine .......... ............. SEEPAGE PIT J Depth ......... Rock filled Yes C1 No ❑O Diameter _-..._.._ Number _-.... 00 Woter Table Depth •--........ ...................Rock Size .................... ...------- Distance to nearest: Well.__Foundation ._._._ Prop. tine ' REPAIR/ADDITION (Prey. Sanitation Permit qlt--_...,.......:......... _ ....... . Date .................................. .y f Septic Tank (Specify Requirements).................................. ......•-------........_..__..__..........._........................... Disposal Field (Specify Requirements),c*... ..........-�-....�.: ................ :tea- ----------- ---- - ------ ............ ------ -- . IDrow existing and required addition on reverse sidel I hereby certify that 1 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 Heallh District. Hem* owner or Men - 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." Signedwner _ O ......... - Title ....oco. ... ................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..�._��' �'°��.............. ..................... .................... DATE �1...:�•{-: • ...... BUILDINGPERMIT ISSUED...............•••-•--............_.,.._...._.-_.............._...__.............._..-•---..........._DATE ......................... ADDITIONALCOMMENTS ........................................... ............ ._.... ._...............__..._.... ......... ..._.............................. ................ :._ :.,: ..............--.::.:::::::.::::::.--- .::::'._::::::::::::::. - :: oote : ......./-__ ;3 .:::.._.........:. -- €inel Inspection by: -.'- -�<'7!�•�.� » - D 13 2b 1-6n Rev. 5f SAN JOAOUIN LOCAL HEALTH DISTRICT 8/74 3H