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FOR OFFICE USE: Y _APPLICATION FOR SANITATION PERMIT ' (Complete In Triplicate) No ..._._... ..................................... This Permit Expires Z Year from Date Issued Date Issued'.. —3./,7c Application is hereby made to the San Joaquin Local Health District for a permit to constrcid and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT# ( , • cENsuS TRACT _ f.... ... ........ ..... Owner's Name ..._---.- � �� ..__- q. -. Phone . Address 30_.t �. ---• ..• .._......City _._..... .. Contractor's Name .-------___-•- .....................-.License#,�.� � ... - Phone -__4� ° `�J Installation will serve: Residence Apartment House fl Commercial E]Traller Court Motel ❑Other� r� ... Number of living units--------- Number of bedrooms ___.. Garbage Grinder lot Size ��_..... Water Supply: Public System and name ............................................... ..........Private Character of soil to a depth of 3 feet: Sand r] Silt 0 Clay ❑ Peat❑ Sandy loom ❑ - Clay loom 0 Hardpan Adobe Fill Material ~ " ' r` --.....1f yes,type •... .......... ............ (Plot pian, 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,) PACKAGE TREATMENT { ] SEPTIC TANK r� . Size._..� x..�....---•-•-•................ Liquid Depth ............. Capacity J�v- -------- Type �-�-_----- Mat Distance -'---- No. Compartments .............. Distance to nearest: Well ` • -•--------��--b.-••------.:{:.....Foundation .....f�-r........ Prop. Line ........ r LEACHING LINE No. of lines ..... —----------- Length of each line.,.......... b._-.---.•. Total Length ----- ...--•••-••-••_--� 'D' Box ...-.LType Filter Material —_...Depth Filter Material rn Distance to nearest: Well .._.. _.. .-_ f=oundation ...-.--10 +- i r r --....--------. Pro Line . .... ... , SEEPAGE GE PIT Depth ...?�. _....... Diameter `. Number --------• --------- Rock Filled Yes No Water Table Depth ------Rock Size Distance to nearest: Well .--•-•--l_.a0-•------------------- Foundation ._--/Q_�f•-__ Prop. Line R9PAIR/ADDITION(Prev. Sanitation Permit# _._.____.___......_ --------- -- Date Septic Tank (Specify Requirements) ............-.......---............. ...........-.............................——....................._.................--................. � 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:Dlstdct. Home, owner or licen- sed agents signature certifies the followings "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 .-... :�.1- --. - ------- -••----..-.--- --------------------- Title ------ OI r than owner) FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY_.--._.C_1- --- -------------------------------- ------------------------------...-. DATE � -.��.....-....-•............. --•�- BUILDING PERMIT ISSUED -------_-----•-------_ .... --- -•- ----- - --------------DATE ---------------•--- -- • - ADDETIONAL COMMENTS -------=------------- - ----------- ---------------------------------•-•-•-•-----...-••----..... _ --------------- -------------------------- •------ Final Inspection by: ----------- -Date _ . -- a - :. EH 13 24 1-68 Rev. 5m � � � -------••------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M