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FOR OFFICE USE_, APPLICATION FOR SANITATION PERMIT L. r tcomplote in Triplicate( Permit Na. _:7 ....'_.......... ..................................................... '........................•--................__............ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San 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: W ... . CENSUS TRACT JOB ADDRESS LOCATION . Q.�....... 4'� / �4.._... � _, .:.. _ _. Owner's Name .. �....• -- Phone 11� �_ .....•.... Address ._>91.4) -IV .........."._....... .. City. . .............. ......................6......... Contractor's Name . _.... .. ` ' 1��S3�2.. - - - - . . ... --- . .....................`....License #�.7.5'.�.?/..__.. Phone - -•-----._..__... ' f installation will serve: Resident Apartment House :) Commercial '❑Trailer Court: ❑ Motel ❑Other Number of living units_____________ Number of beddrroomps -......Garbage Grinder .._......__. Lot Size..9Q5'lf 1 0-�....:_........: Water Supply: Public System and name ._ r�L�._.1'ill ---_•---•-•--•_-•.............•------------•------'-- ..............Private ❑ Character of soil to a depth of 3 feet: Sand Silt I]`,�F Clay ❑ ' Peat❑ Sandy Loom ❑ . Clay Loam ❑ ` Hardpan ❑ Adobe S-�Ill Material ............ lf: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,)' PACKAGE TREATMENT [ ] SEPTIC TANK( l Size............................... ................. Liquid Depth .............. Capacity ......._.. Type ................. Material------------- .. No. Compartments t Distance to nearest: Well ...................................Foundation ...................... Prop. Line ................. LEACHING LINE [ ] No. of Lines ........................ Length of each line.-......... .......... Total Length ............................. D' Box Type Filter Material ..Depth Filter Material .......................................... { Distance to nearest: Well ..:..........:......... Foundation ------•----------------- Property Line .-•----.... ............ SEEPAGE PIT ( j Depth ---- .....:....... Diameter ............ Number .... ....................... Rock Filled Yes 0 No 0 Water Table Depth ..... ..................Rock Size ........:.... ._ ........... Distance to nearest: Well.........................................Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .......................................:.... Date ................................... Septic Tank (Specify Requirements) ............-....................... 3.. ........ ........•--- M Disposal Field (Specify Requirements) -----� L?..... - ------ -•- ------------- 4 .......................................................................•........___...._..................__......_.____:_..............._.._____...__......_.._......__....____..___._-----*---____.___. '(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, antl Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. ksed 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'Cornpensotion laws of California." 4 Signed _. _.._ .. Owner By _ �•�t r ......................................... Title " . ......----......_............._....__...... (If other than wned OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. �...: .. ._ _ ---------- --------- ................... ........ DATE I'a - fI?_ _........ BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS .. . .: ). ................... ......... ................... ........................... . ,_.: =.::............ ::::::::::::::: ::::::::::::..._::.:::::::: ::::::::::::::.:__::::::::::::::::::::::::::::::::: -•-•--------•-•••.•••.............. ...... _•... .. _ ..........- ........................ Final Inspection by- ----------•- - ••----••.-----•- e - Dat .:, �.. SAN JOA IN LOCAL HEALTH DISTRICT F w 1- 24 I.-AR Rwv Anti 7/72 /72 3 M