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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ]� -,cJ G ......,..............................:............_._._.. . . � {Complete in Tdpllcate) Permit No. .................. . ............. This Permh Explrss 1 Year From pate Issued Dane Issued ..../.1.:.,. c. 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 Count Ordinan No. 5449 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..�_�. ... CENSUS TRACT Owner's Name ,nt .. .............. r ....... Phone .................. ........ Address ....... .. . f ...... ... .. .City ..... ........... ..-••-•---. ....... -------------------ate• Contractor's Name ........... .. . •-•-•--•----............Lltensa � `• i Phone .� f� -e-y, Installation will serve: Residence Apartment .ouseQ Commercial QTraller # Q Motel0 Outer................................................... Number of living units:......... Number of bedrooms . .....Garbage Grinder ............. Lot Size .... . .. ..... .... Water Supply: Public System and name ------------_ - --- .Private Q .. . . .. .. . . .... Character of soil to a depth of 3 feet; Sand Q Silt Q Clair ] Peat Q so"cly LoatrCie y .Loam Q �Q Hardpan❑ Adobe Q fill Material ............If yes, Ian, showing!Piot p g size of lot, location of system In relation to wells, buildings, etc. must �e placed on reverse side., NEW INSTALLATION. )No septic tank or seepage pit perml"d if public sewer is availabl*wlthln 200 fust,) r PACKAGE TREATMENT SEPTIC TAN#C{ ) Size .. ........,.._ I tqulc Depth ,- .r.. ... Capacity A1C;- Types -.HT1.. .. Materlol.-Ce ---- Not Compartm*nts :�. ... Distance,to nearest Well r4'IF ._ dPtlon , ... Prop, line . .. .��!.. LEACHING LINE [ No. of Lines ....-V. _._...._.. Length of each llntt...__: `_ ..__ T+p#al eLength ..... ..*. ?........ 'DSox , ..... Type Filter Material Depth filter Material . .6`. .................: Distance to nearest: Well ........................ Foundation Property Line ............. h ` �FAs�-SIT [ � ire pl �•••X•P4-X/�)7irtmeter ................ Number ..........';R'............ Rock filled Yes� No Q Water Table Depth . , ... . . ............... .Rock Size ........... ... .. Distance to nearest: Well _.Foundation ................ Trap. Lirte ...................... REPAIR/ADDITION(Prev. Sanitation permit ...... Date ........--.................... Septic Tank )Specify Requirements) .............. ._.-- . .. ......... ....... ..............,................ DisposalField (Specify Requirementst ....................................................:............-•-----............................................................. .................. ------------------------------------•---------- ---------------...,.•- .......-........................... --------.-_..................•-•-- ............................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the worst will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dkirict. Homo 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 Workman' ompensation laws of California." Signed .. .........•---- ------- - ------------- Owner By ---- ..... •-- ----- -- -- _ .. -------•-._....--- .Title --------- ---- ............... -----------......................... ( of r th owner) FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---..... . ............. _... DATE ......1�-.. - !.-��........ BUILDING PERMIT ISSUED -.. ..... -----------------------DATE ---•....................................... .._...-.-..---•. ...............•••-•----... r.-.. ADDITIONAL COMMENTS ................ - -----••-------------- --- ------------------------- .....................................-......------•..........--- -------------- --------- ----- Final Inspection by: -------- _ - -- --------------------------.....................................................-Date -.�... .-�..' ....��_.__......... . E:H 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 6/74 3M