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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Z.(Complato In Triplicate) Permit No. ......... .. ' ... This Permit Expires f Year from Date Issued Dale Issued ' :.7 .: 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 complian with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION • 1 r .................................... .._ . . -��. ...� CENSUS TRACT ..... Owner's Name -------�¢� /� •-•-L .fAx/6.....................................................................Phone ..:............................. ob- ....cit,► --------------- _ Address __.-... � 'c`� -----•---- .......... . •-----..�.------•... f .................. Contractor's Name __.:___ --r�4-f,( .... ...... .......License 9lt Phone Installation will serve: Residence❑Apartment Houset] Commercial❑'frailer Court ❑ Motel ❑Other............................................ Number of living uni#s:.. _._._ Number of bedrooms .....Garbage Grinder . Lot Size ................ Water Supply: Public System and name .................................-.....................-........-_..............----......................._Private Character of soil to a depth of 3 feet: Sand Sift Cla Peat Sand Loam Cla Loam (� p C� ❑ Y ❑ ❑ Y ❑ Y D Hardpan❑ Adobe X 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,) PACKAGE TREATMENT ( ] SEPTIC TANK i ) Size.-_........................................... Liquid Depth .......................... Capacity -- Material................... No. Compartments Distance to nearest: Well ....................................Foundation ----------------....._ Prop. Line ...................... LEACHING LINE [ j No. of Lines ------_----------_-- Length of each line............................ Total Length ............................ 'D' Box ............. Type Filter Material ....................Depth .f=ilter Material ............................................ Distance to nearest: Well ........................ Foundation .._ .................... Property Line ........................ C SEEPAGE PIT. Depth ---- --------------- Diameter ----•-------- __- Number ............................ Rock Filled Yes ❑ - No ❑ I .x ( � - Water Table Depth ----------------------••-- .....................Rock Size ---••--••----•---•---- ------ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------- -------- Date .........__..___...____........... Date ) Septic Tank (Specify Requirements) _.A104- .� 4- -- ---6 . _ �% �,�,-r�e e Disposal Field (Specify Requirements) -------................... •------------------ --------------- ---------.....------••-------•-......•---•------••--•-- .................................... ........................... {Draw existing and required addition on reverse side) 1 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 became subject to Workman's Compensation laws of California." Signed -•----------- ...... _----------------• ------- -------_---------- --------- Owner BY ..... ----------- ----------- ............. Title . : -. �A�'------------------------ ther than o her) _ fClR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �- ---------- - e�-'-----•------------ --------------- DATE -..��.".�'_-�----------•-------- BUILDING PERMIT ISSUED --•----------•--------------------------=-- --------------------------------------------- DATE ....._..........:.........---------------- ADDITIONAL COMMENTS -------------------- ----------------------- ------------------ A, '. 9 .... --._..-----•---------------------...__... c .. -I • .. ...... final Inspection lay: .: i!�.... Date ....._.(f... 9 _.7�....... EH 13 2a 1-68 S#4 JOAQUIN LOCAL HEALTH DISTRICT 874 3M