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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y i (complete in Triplicate} Permit No. ..7 �_........_ ..........I.......I................................ '......................................................... This Permit Expires I Year From bate Issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: kJOB ADDRESS/LOCAT N ............ .�1. .............................CENSUS TRACT .............::...... :..... Owner's Name ........ t.j !l� . .... .... ................... ........ :... ... ............Phone .................................... Address 1City .. ............................... Contractor's Name ...... . .. .. . .... __-. -----. - --License # _ g........ Phone.............................. F Installation will serye: Residence Apartment House❑ Commercial pTrailer Court .C] 4 Motel ❑Other --•-.--. ...... ...............•• Number of. living units:------ Number of bedrooms .��* ....Garbage Grinder .._... ..... Lot Size .Q- .. t .:............ Water Supply: Public System and name ....................: Private ------.------•.----•---•-•-----•-----•-•-•..........................I._....._. .. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ - Peat 0 Sandy Loam ,Clay Loam 0 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..:.............................:............... Liquid Depth --.._------------.-------- a I , Capacity ----------------_-:'Type .............. Material..:_....._............ No. Compartments ....................... Distance to nearest: Well ..................•-•_-- :,..........Foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines --------------- -------- Length of each line............................. Total Lerigth ............................ 'D' Box J________ Type Filter Material .. Depth..... Filter Materi ... .......................... Distance to nearest: Well :..................:...: Foundation ................. __.__. Pro a Lane SEEPAGE PIT [ 7 Depth ...: ............... Diameter f............:.-.: Number ..---------..............._.. Rock-Filled. •Yes r . .No Q • Water Table Depth ----------------------------•..--•-•.. ...... Size ...............:..:--•--•--•-- Distance t I nearest: Well --•....................Foundation .................... Prop. Line ...-•--•---•-- ....... � REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date .........................._....... ) " P Septic Tank (Specify Requirements) ............. ......_ ....__----••-- ---••- Disposal Fi d (Specify equir ants) ....G��. .. 4, --.... .. " a � � --••-------•------- - ----------- - --.•---- --• •--•- i .................... .......•.---..... ..........................................................-•-----..................................----.................. ---.................:::- ._..... (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. dome owner or licen- 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 nsotion laws of California," Signed ............................------------- �. ._... Owner �. BY ( +' --• .... .. .............� Title 4r......................................... (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..--. ---------�/�r•---.......-----•-----•.....---•-•-_....__..:---•--.....__......-•-....... DATE .....71�e�.�? .............. BUILDING PERMIT ISSUED .....---- DATE ......... ........ --� ----------------- I ADDITIONAL COMMENTS ......77' _ ....... �t .P �.. -•............................... r ----------------------------------------------------- --•-------------------------------•--------------------- -------•------- --------------------------------------- --.............-•-----•- ..................•---...._._....._..................._......................._..---•-•-----•-•--•--.._.. ......................................................... ................................ = ............................. -•-•-•• - ....._.. Final Inspection by. .............. , D �.......---......-----•---•--•---......:..................__._. .............................. ate ...._�I, ..:�,i' _.�r�-................ SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 24 1-'68 Rev_ 5M 7/72 3 M