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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. .................................... ....•..---.... IlComplete in Triplicate) Permit No. _ .......................... �`f ......... ............... 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. 549 and existing Rules and Regulations: ' 1 JOB ADDRESS/LOCATION . ...-.-...l..`.... ............ C...E.N..PShUoSneTRA-7Cs T .............�.. .............. OwhesNome . .kffwf .._..----.-•----•--�-- ---..... Address .......:........... _ . . Contractor's Name -- -•- --..y�F.+` .... /?t1�t/ t_5.��... ... b ----------------License # ` -T .'.-Phone _466-%6:x.7 I Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ;❑ �. i Motel p Other ............... -----•---••------•--...- Number of living units:.. .. _.... Number of bedrooms ...3-......Garbage Grinder Lot Size ..�.�.� .......... Wafer Supply: Public System and name ------------------------- ----------------- - ................................. ..................Private Char racter of soil to a depth of 3 feet: Sand Silt❑ Clay E] Peat❑ Sandy Loam ❑ Clay Loam E] O 1 Hardpan..-Adobe. ❑ .Fill Material.... ... If-yes,type-ry,......... ....... .....•- •. (Plot 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 [K SEPTIC TANK Size.—7-oR._KK 4"-`�`-j_X..�.`..� Liquid Depth ,..�(.f f......... Capacity �Z __... Type 14er4.5c- MaterialNo. Compartments ................. I Distance to nearest: WellQ..`' --------------Foundation _..._ jrq`.,'_. Prop. Line __2_5.� ..._ LEACHING LINE ( No. of Lines--. Length -of.-each lure �.�_.._, Total Length _.. ._ Cl D' Box Type Filter Material ._ C_e __.Depth Filter Material _._fs.11......... ... Distance to nearest: Well ......f _f�`_ Foundation___9©F..._..-._. Property Line ..__ r..._._..._ SEEPAGE PIT [ ] Depth p S. .. Diameter -.7�---_.-_ Number �] is . .. �------ ----------- Rock Filled Yes Na { Water Table Depth .. .�sr 2 .~...._ .............Rock Size _1 _._....._..._ Distance to nearest: Well __....�� -- ------------_---Foundation ./ .�'c.... Prop..Line ---. ?�,.. .... REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------- ---------•_...... ... Dater -------------------------------- Septic ----_-.-----_------.---_-----_Septic Tank (Specify Requirements) --- •-- •---------• ------------------------------ ------- ------ -------------------------------- � 3 Disposal Field (Specify Requirements) --------------------- ....... --------------------- .. ...... ... ......----........ .............................................. in . I (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, 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 mannor as to become s 'ect to Workman's Compensation laws of California." I Signed ........... ... By Title (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .3,r.. , .. _ ..,._. .:... .. DATE " ..... ...... . . - ._ ............. BUILDING PERMIT ISSUED .. . ........ _..-.... -----------;......._....--- DATE _ _.._........-a ..._......... . ADDITIONAL COMMENTS ................_, ......-•:--;- ---------- ----------------------•-- Y..... ....-•---.... -------- ------------------------------------ --- ......... ........... ..... ------------ ---------------------- - -----------------------•------. ----.._.--- Final Inspection by: ..-•-- -'--... - -- Date ff � ` �...;..... .. ....... -._ .._...--- .. .-- ....... ------------•-_.- SAN JOAQUIN LOCAL HEALTH DISTRICT E.H13 24 1-'68 Rev. 5M ----____- 7/,72 3 M