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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............... . 7 (Complete in Triplicate) Permit No. _.7y: ... ......................................................... 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/LOCATIONr._CENSUS TRACT .......................... Owner's Name pYTt. .. ....................................... ........... ...............Phone-------•------...................... Address ..... City ...... + Contractor's Name ...... �?!t c ...: ;rte.-. .--._,....License # .. . 2- Phone ......................... .... ..... Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other __._2'? - - _._.f.�"...?!ra. 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❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay loam p-- O 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, see age pit permitted if public�ppublic sewer is available within 200 feet,) r PACKAGE TREATMENT [ SEPTIC TANIC Size.�*4R... �. _. .� Li ,� . .._._._._. quid Depth ...�................... 10 Capacity /.7�:'a.... Type ._.... .... Material---� No. Compartments .. --......:.--. Distance to nearest: Well .......SO.....................Foundation ......... Prop. Line ......66............. LEACHING LINE [� No. of Lines ....... ............ Length of each line.___.__—#-P............. Total Length ..L., a.............. 'D' Box _J------ Type Filter Material ... _ .......Depthi Filter Material ......./.,I .............................. Distance to nearest: Well ......... Foundation Foundation ........I_A.'o---._-. Property Line ......6............. SEEPAGE PIT [ Depth ..._,ra[__ ... .. Diameter. ....� Number --------3................ Rock Filled Yes [5" No Water Table Depth ...............�� ' / .-- _--------Rock Size------ Y2 0''� S" �° J Distance to nearest: Well ........J,-Bo.......................Foundation .___.`_P......... Prop. line ......Ir REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -_................................ SepticTank (Specify Requirements) ......................................... ---•-----••--•-- .............._........-...................................................... Disposal Field (Specify Requirements) ... .............---------------------------------------- --•---------------------------- ....................__..-------•------- --- - - - - ------ -- (Draw existing and required additi----on 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. Home 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 Workm Compensation laws of California." Signed ............................... ---------- ..._ -- .....d._._.:_..------------ Owner By ...........................•--- .....F._ L !'-- .__. _...... - title ... _ (if other than owner) r, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.... ......I.................... ...... ........... DATE .......... BUILDING PERMIT ISSUED ...................................... ......................................................................DATE ........................................... ADDITIONAL COMMENTS ...............••---••..._..........................-----•....------...__.... ---•-----•... .........:...---•---------------------.....-----•----.._...----••---...-----•--..--.-.._...--•-----------•-----�- -------- ....... . 1 .................. ............ . •-----...-• ..._..... „-._.__ Final Inspection by: .Ci► �.r� ...............Date ...._... .........` ............ SAN JOAQUIN LOCAL HEALTH. DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3 Ni