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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . ._.�..................................... .• gap (Complete in Triplicate) Permit No. ..7. ::7f< ..... ....................... _........ ��a� ... ,� Date Issued •-•.-•••• /?,.. . .....__�'+!'! ..... This Permit Expires 1 Year From Data Issued Application is hereby made to the Son 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 apd existing Rules and Regulations: J08 f� ADDR.�ESS/LO C-A- • - --r- . - e -. .-�•- C/- . _. ,- 49N B TRACT .. RACT`--------- ------ Owner's Name ...... Phone , Address ------ ... City ............................ ..........._........... .... Contractor's Name icense #p "�,�t'�.. Phone� I ° -.- Installation will serve: Residence Apartment House J-] Commercial ❑Trailer Court ❑ Motel ❑Other --------.-!.........-....................... f Number of living units.-./-..- Number of bed ooms _......Garbage Grinder . " Lot Size ..__._ �-4--- ... Water SuPPIY� Public System and name ...... - - -- • ---------+G'`,V ..........................................•----._.Private 5�-� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe [] Fill Material ............ If yes,type ____________________________ (Plot plan, showing size of lot, location 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,) J PACKAGE TREATMENT ] SEPTIC TANK Size.. .. ,. ...x .._._._..._ Liquid Depth ...2$.................. d CapacityrC} !_.> TYpe , d. .. aterial Compartments ---- .......... Distance to nearest: Well ---- ..f..................Foundation Ae--- ........ Prop. Line --t� :........... LEACHING LINE [ No. of Lines ....c;!............... Length of ach line._. � _�_._._._... Total length .._ r�.<C".f...._. 'D' Box Z.- Type Filter Material Xi ....Depth Filter Materiae ...,�� -Distance to nearest: Well .�` ........-.. Foundation ..�. .......... Property Line .tS............_. ef SEEPAGE PIT Depth ...._.._. Diameter ........ Number ___-._cZ----------------- Rock Filled Yes ' No ❑ C .� r Water Table Depth ... ... ........Rock Size ...c Distance to nearest: Well r ..Foundation - ` Prop. Line >.� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................j Septic Tank (Specify Requirements) DisposalField (Specify Requirements) ----------------- ............................ •--•--- -------------------------------------------•- ---•--- ........ ............... -----••--- ....................................................................--.............................................................................. ..................... ----------------- .._....--------- (Draw existing and required addition on reverse side) I hereby certify Haat 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 [icon. 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." Signed ... .............................. Owner By ,._....._. _ _,r�.--•---------------------- Title __.._ .........._._.._-- ..._._._...__... --------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... -........... =... /¢ 7 •_....:--------•-- DATE ........ ......• •--•................. BUILDING PERMIT ISSUED ... ..._._... ...........................•-- ..............:..............DATE ADDITIONAL COMMENTS �rz .... ....... gw , .°................. ..I.._.._ . . •. .. . -- -----. Final Inspection by: _....._... �,.`�' ...... .... ..........................................-----•----•...... .......... ..........•-•-.........................__...Date ...< - � 7.. __....._.._- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 1.3 241-'b8 Rev. 5M 7/72 3 14 ��