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FOR OFFICE 115E: APPLICATION FOR SANITATION PERMIT S 3�j 1r ...... ........... ....... .....•- Permit No. ...7.._. ........... {Complete in Triplicate} ........................ 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 made in compliance with County Ordinance No. 544 and existing Rules and Regulations- JOB ADDRESS/LOC Ti �OD.. 47 ,.* _.f---- - '�1. -.- -- .....-...............CENSl15 TRACT ..---......-- Owner's Name Gy`'- �........ .._ C q7/U hone=-77 ............ Address . .. ` '" �` ' ... -I�-��-----.. City �.............. ..-•-- r Contractor's Name .. o. .! _...- phone . ..._�.� Installation will serve: Residence WApartment House❑ Commercial ❑Trailer Court C) Motel ❑ Other - --- ... ----------_---------------- h � Number of living units: ... Number of bedrooms ..----Garbage Grinder 00. .. Lot Size .. � �-.• .--•-•..• Water Supply: Public System and name --------------------------------------...................Private 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.) y NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200 feet,) S PACKAGE TREATMENT [ ) SEPTIC TANK [ Size..---------_--....._.... ......... .......... Liquid Depth ..........................r Capacity {hod Type Material.---.... - . P! No. Compartments - ..... T e�YG ! 'stance to nearest: Well ..................Foundation .1 ............ Prop. Line ._-_._-..-__-_..__... LEACHING LINE (&Jl No, of Lines Total Length _ . Lingth of ach line ..... 'D' Box Type Filter Material aDepth Filter Material f .-..�.........�........ ......... � ._._... ' '1137 Distance to nearest: Well .. -..` .._-f .9undation ............. Property Line _.........--.- SEEPAGE PIT Depth ----_.._ DiameterX. ,Number ... � . ..--.-.- -. Rock Filled Yes �o [� P � �jr�aF1G Water Table Depth ----_ --------------------- ...........Rock Size ............. --................ i Distance to nearest: Well --- --------- ------ ........Foundation ......... . ------- Prop. Line .__..--.---------.._.. REPAIR/ADDITION(Prev. Sanitation Permit# ........ ... ....... ---------... ....._ Date -----------------__------------1 � rb Septic Tank {Specify Requirements) . .... ................... ------------- ------------_----_------- ••- --.... ............. ----_------- Disposal ---._ ------Disposal Field {Specif Requirements.) ---------- -- ----------.....--_ ... .... •---.. . p .. -- ....... .---....- -----• ........... . .......... ---- 1________.___------ ------------- ........ ...... . ....._.------.---------------- ..... (Drtiw 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 haws, 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 w 'ch this permit is issued, I shall not employ any person in such manner as to beco u ec o o kma ompensati of California." Signed .. --------- --- - --- - --------- •-------- Owner ._... ... Title ...... ................ If ther than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . .. ... i._ - --------- DATE . . .G..'�✓� .�.� ......... BUILDING PERMIT ISSUED .- .... ..-_ _ ...............••.-- -..--- -..... DATE . .. ................ ADDITIONAL COMMENTS -.......... ----6tCIP _.-5. .. ._ . ..... . - ..................................-- ----.......--•-..--------------------------- .................-- --- --- .................... ..............-------...................I........... . . .................................. .. _........._.. ...--------.... ............... ............... --------------- .......................... .... .............. - - .. Inspection by: ---• - ..... ... ----------------------•----------------- ----------..Date ----------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M - - _ 7/72 3,�