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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Triplicate) . This Permit Expires ] Year From Date Issued Dote Issued • ... .7.�1 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/LOCATION ...-CENSUS TRACT Owner's Name ...._� / -i_.�.d ?.i .� � / .............................................................-....Phone ..._......._.......1.1...........--- Address .:-...--•------ - ./... . ............ ................City ...........:...................................• ............-•••-•---_... ZtContractor's Name -------- - ..' 1lfe-a__--- . .......•......................License # Phone 7 �4;/X . Installation will serve: Residence artment House Commercial❑Trailer Court r , Motel ❑Other...-•-----•--•-•............................ Number of living units .......... Number of ms ..—,. Garbage Grinder h ... Lot Size .............: Water Supply: Public System and name ... l ...._ .................................................................Private ❑ Character of soil to a depth of 9 feet: Sand Silt eat n l M ❑ ❑ Cla Y ❑ Sa dy LNm Q Coy Lim ❑ \ s - Hardpan Q Adobe, ill Materlak�1..... If yes,type (Plot plan, showing size of lot, Iodation 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 .................-_.. Type-----------------------Material............ ......... No. Compartments ...................... Distance to nearest: Well .............................. .....Foundation ........... Prop. Line .............. LEACHING LINE ] No. of lines ------------------------ Length of each .............. Total Length i V Box ............. Type Filter Material ....................Depth .Filter Material ..............................•-------.-.-.- Distance tofnearest: Well ....____________________. Foundation ..._-.-.... . ..._______ Property Line ..... . .. SEEPAGE PIT ( } Depth ......_____._ __- Number ............................ Rock Filled Yes ❑ No ❑ Diameter ___•----_-• - � y Water Table Depth -------------".......:...........:: .......:...Rock Size -------- ..................... Distance to nearest: Well ..............................Foundation ..................... Prop. Line ................. -•�- x REPAIR/ADDITION(Prev. Sanitation Permit r# ---------------------------------........... Date ------ ............. Septic Tank (Specify Requirements) • --------------------------------- `----.---- -------------------------- ...... -................. ........... ..................... . D is oral Field (Specify Requirernents) .___-_____ _ ___ -----------------------..._ ---- -------------------------------------- .................................................. .... '(Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be Clone In accordance-with San Joaquin - County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heal&,District. Home owner or licen- sed agents signature certifies the following: "I certify that In the performance ofi the work for which this permit is issued, i shall not emploi any person In such manner as to become subject to Workman's Compensation laws of California." Signed --- •---------------- Owner V ,* �� title - (If o than owner) , r FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY ----- _ _ -..DATE . BUILDING PERMIT ISSUED . ..:. -------_/ -------------------•---•---..............._DATE .................................---•---- ADDITIONALCOMMENTS ------------- --------------------••-•-•--•---•--...-••----•-•--......._...-------...----._.....----•------• -----------.. .................................... -------------- ------- ------------------------------------.••---------- -------------------.-_.. . -- .-. ..-- --- --- ------._._:-----•---- ------...__._------------...._- •�. t - Final Inspection b p Y: _-------------------------• ...---.Date ... �(._. EH 13 24 1-013 Itev. 5m 5 - } d /'3 � =- SAN JC?AQUlM LOCAL HEALTH €�ISTRICT 8/74 3m �