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FOR OFFICE USE: `.r4... APPLICATION FOR-SANITATION PERMIT (Complete in Triplicate) .............................................I...... ' Date Issued . 3. 73 ............. .------------ .__...... This Permit Expires 1 Year From 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. 549 and existing Rules and Regulations: JOB ADDRESS%LO'CATION -------0._ .T..............�5-.. ....................................CENSUS TRACE' .......................... Owner's Nari7e — . _ __ ,_ .T....� `.. ...._... ....... ' !/ ::�[. s--...... �`.t.. . :.,...... .Phone . 1.��, ._ Address ......................... ............................................ City .....---......................................,.... Contractor's Name0- ..........License # Phone 7: .'....... Installation will serve: Residence ®Apartment House❑ Commercial❑Traller Court 0 Motel ❑Other ------------ ............................... Number of living units:..__- Number of bedrooms ---____Garbage Grinder ............ Lot Size - lP..... ...... .......... Water Supply: Public System and name .......... •------ ..............................Private ❑ Character of soil to a depth of 3 feet: Sand�] Silt❑ Clammy ❑ ' Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe [& Fill Material ............ If yes,type __-_____._-__---_i-_--_-- (Plot plan, showing size of lot, location ofsystem 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 t Size................................................ Liquid Depth ...._---.._._______._.__--pk) Capacity .................... Type -------------------- Material---...__.............. No. Compartments --.................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line LEACHING LINE No. of Lines .........f'........... Length of each line------- 11...`.......-. Total Length ...�lq..`...._._..._. 'D' Box ------/---- Type Filter Material .........�.. ..Depth Filter Materio` ....... _.:_.........................� Distance to nearest: Well __..._._-- .......... Foundation .......V.OZn° ..... Property Line ._ <L�.......... SEEPAGE PIT [Yi Depth t....... Diameter ---- Number ........L............... iRock Filled Yes Eff No ❑P Water Table Depth ._ .- g .............Rock Size Distance to nearest: Well ....Foundation ..... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ., ---•---•----------------------------•------. Date ......................... Septic Tank (Specify Requirements) - i z�.. -••--�.-/Y....�_.�•.--�.-.--.•_•------------- Disposal ----••------Disposal Field (Specify Requirements} = --- --. -te Y A - r .- --.... �. .......... = - ----------------------------------------................................. (Draw existing and required addition on reverse side) I her4 certify thmt 1 have prepared this application and that the work; wiil'be.done in accordance with San Joaquin- County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lo al'Health District. Home owner or licen- sed agents signatilre certifies the following:,- "I ollowing:,"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`'--...---... �....................... ..........................�. TiNe .....� _...........__._.._........ (if her than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ ••--- •J.---•-�.. ) ! ...---•--•------------------•-•--.... DATE ..�.......... . J/ �� BUILDINGPERMIT ISSUED ..................................................................................................'.r......DATE ................•.......................... ADDITIONALCOMMENTS ......................... ..............•................................ .................................. ------------- ......................... ...................................... --=---------- ....................-.............-........-................................... ......................................... �• ----- ... ........... ---........ . -----_. Final Inspection by: .....--- ._... Date ...... �-L_r._._J. ...... w SA JOAQUI LOCAL HEALTH DISTRICT 1 E. H.13 241•'68 Rev. 5M 7/72314