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FOR OFFICE USE. L O y$ S 7 D ��1��- APPLICATION FOR SANITATION PERMIT ................................... ....... _ Permit No. Z' — 7 (Complete in Triplicate) ......................................................... • Date issued ......................................................... This Permit Expires i Year From Date issued t 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/LOCATIONt ..._.... ,/ `..... :... CENSUS TRACTy._.... Owner's Name ._.. " .. - r/.......................... .•-- --- --- Address ....... ... ti.... city .. L Contractor's Name ... ... _.License #pZ(C71Z_ ..--- Phone Installation will serve: Residence `Apartment House❑ Commercial ❑Trailer Court ❑ Motel f] Other .... -------------------------------- Number ------------ •-------Number of living units:.....- Number of b drooms .......Garbage Grinder 71577 lot Size ....� ---------- ' Water Supply: Public System and name _._.. .. ... ---- ..Privafe ' Character of;soil to a depth of 3 feet: SandE]. Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam or Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ � i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) l NEW INSTALLATION: INo septictankor seepage pit permitted if public sewer is available within 200 feet,) n J PACKAGE TREATMENT f 3 SEPTIC TANK Siz _.... .r � - -- - liquid Depth .. .--•_..--..••0 Type/ . .. . Capocity� Ch2:� r Material .. .. No. Compartments ._ (;; ........••.- ,R r Distance to nearest: Well V.....................Foundation ...1 _.. . -.. Prop. Line ..t -----•. 6� LEACHING LINE ,j�' No. of Lines Length of each line......[ 0�......-.-..- Total Length .�.��.�.._...:.. 'D' Box Type Filter Material /la .._.-._Depth Filter Material _... ....._........ .................... �- I Distance to nearest: Well .. _...__.:_ Foundation Property Line Al... .............. SEEPAGE PIT Depth ------ Diameter x2J."o Numbe. .....c2.------------- -- Rock Filled Yes ;No ❑ , Water Table Depth. ........... .................Rock Size ...0.-!�------------M...... Distance to nearest: We --- ---------------------Foundation _.fC3.......... Prop. line .. ................. i REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- .....- ....... Date -----------------------------------I Septic Tank (Specify Requirements) ..------ ......---.........--------.................-...........-•----......_........_........--....._..._......._.......------....._..-- j Disposal Field (Specify Requirements) ........................._--•----•-•------ ---- --------......- --.................... .... ..L------------------------ I -•----- -- --------•----I --- ------------ --------------- ----------- ..................... ........... -------- _ __ _ _ _ - ------------- ------ • - ----------------- ..................... ... ..... .............. ---------- (Draw existing and required addition on reverse sidel I hereby certify that,l have prepared this.,application and that the work will be done in accordance.with San Joaquin i 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 ... .. .... !".'c, (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... .....:. ._-._... ------. ._DAT E .._dV _. ................ BUILDING PERMIT ISSUED ........__.... ..... ... ... ...• ----- ...............DATE . ....... ............---- ........ . {'`ADDITIONAL COMMENTS ........... .- ----------------------------------------- _.,.-................._............. ._..._. ...........-----...........---......... ....... '.1----------------------.....- ..-----------....---.-----------------.- ----- ..._.. ........ .........._.......... I F Final Inspection bY: ..-•--- ...--•----------.M..... • ---------- ate ... . c i SAN JOAQUIN LOCAL HEALTH .DISTRICT —_ i c u 13 24 1 -,Lo oe., cie"" _..... _ 7/72 3 M- ..