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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....... ...................................I. (Complete in Triplicate) Permit No. ...`�7:.:..5�a . --.......•-----'•--•'-_ ' This Permit Expires 1 Year From Date Issued 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 mode in compliance with ounty Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION .........��! .... F ............ ::......1 •-`-•. e....CENSUS TRACT .......................... Owner's Name ....... hone .. .......................... ,i Address ... .-. - �z. -�....fr"-+ CitY `�' ... Contractor's Name!.�� .c ,,,(L--•• r _.. License # x�-~l�t,Z.7. Phonex .• Installation will serve. Residence ❑ Apartment House Commercial ❑Trailer Court 0 Motel ❑Other -----------------_-------.... __- ------ Number of living units:..- Number of bedrooms ...Garbage Grinder . Lot Size . ....GO��. -•••••• -. Water Supply: Public System and name ...... -•--- • - Private rtK Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan 0 Adobe ❑ Fill Material ............ If yes,type -------•.................. (Plot pian, showing size of lot, location ofsystem 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 5ize._r► l�-- - e _-.l...-� ... Liquid Depth ....47_-.or.......... Capacity .4lrr.`TypeL44Material Compartments ..A=_........... � Distance to nearest: Well ___ 'C ..'........... .........Foundation ------------- Prop. Line ..? .. __...... S LEACHING LINE No. of Lines .....�.............. Length of each line------- ._ ._..... Total Length ... '...r..--...... (1J 'D' Box ..`---- Type Filter Material 4•._•._.-Depth Filter Material ---/�`..f...................... Distance to nearest: Well `.............. Foundation ..../ ............ Property tine -.0 ............... f SEEPAGE PIT �'' Depth c �� -..-..... Diameter �-------------- Number ...... Rock Filled Yes No Q�' � - Rock Size -... .. r • Water Table Depth ._---- � ` �-•--�-••.......... G Distance to nearest: Well ... a..... .................. .. ..C! .... Pro Line _�� _�..._...__ REPAIR/ADDITION(Prev. Sanitation Permit# .......................�......-__......_--. Date ..............................i � ' Septic Tank (Specify Requirements) ...... -.--..-Cyr- Disposal Field (Specify Requirements) ......... . ........ :. .. .... .... t--- •-•---.. ...... --••---------- -•---- ............. _....-_.................... ..............•---...........------....-------•-•--.....----------------- ....-........................................-.-................................................. (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 Iic*n- 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 mann*r as to become subject to Workman's Compensation laws of California." Signed ..--------- •-• ------------------ •..........--•--------- . ..... Owner By ........... ... .. ------..-....... Title _._.�.,r 7-........--...........--....... " If other than owner) FOR DEPARTMENT USE ONLY La APPLICATIONACCEPTED BY --------------------.........................•..........................................---------_ DATE ----4?- ...`t` -,7Y-............._ BUILDINGPERMIT ISSUED ---- ----- --------------•-•..-:....•-•-....... --------- ......•----------....I..........DATE ..... ------------•-•- _-------- ....... ADDITIONAL COMMENTS ...-� 7 ......... _' ...........I----------------- ----------- .........•--•---................-----................ ..-. ............ ................................................... ... .. ..................... ................. .......................... 1 ...................... . .. ,. .-_. ..-...__.-.--_--...........---•----------_•-_.....--..._------......---------------------------- -------- --------------- . ... .r....... FinalInspection by: --- ---- - -•----................._._................--------.....• ...Date .....� ... .. __.. .. ..._. SAN JOAQUIN -LOCAL HEALTH DISTRICT I E 7172 3 M H-1.3 24]-'68 Rev. 5M