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FOR OFFICE USE: e f APPLICATION FOR SANITATION PERMIT ...............t. --•-------•--..._...............a-•-- 3p Permit No. ..7 �_ 3` (Complete In Triplicate) ..... :......__�r...............3:....... -.: �o- Date Issued ............. .-.... .........................................:............... This Permit Expires t 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 CountyOrdinanceNo. 549 and existing Rules and Regulations: JOB ADDRESS LOCATION ...........CrN5U5 TRACT �.... .................... Owner's Name .................................. .�..... Ci Phone Address .....: .• ... .. ...:� ,, -. a Contractor's Name... _j_- ...- a-m_�- --. -•--. ......License __..... ....------.._ Phone . Installation will serve: Residence Apartment House] Commercial❑Trailer Court C] Motel p her -............................................ ! Number of living units------ Number of bedrooms _.?�Garba a rider ---.�..'] Lot Size .. Q.... --�Z' ...•.•-.... Water Supply: Public System and name ......................................................... _:..{;dl ... !.......Private❑ Character of soil to a depth of 3 feed Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam.0 Clay Loam Hardpan p Adob��lll Material ............ If yes,type ............... ............ (Plot plan, showing size of lot, location of system in relation to weils,"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................................................ Uquid Depth .......................... Capacity ...:................ Type -•--------••-------- Material...................... No. Compartments ..................... Distance to nearest: Well --------------- ..............._Foundation ..........--.......... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ........................ Length of each line........................:... Total Length ........................... i} 'D' Box .._......... Type Filter Material ....................Depth Filter Material ............................................. Distance toynearest: Well ............ ...... Foundation ---..................... Property Line .......................3 SEEPAGE PIT [ ) Depth .................... Diameter ....... Number .... ....................... Rock Filled Yes ❑ No Water Table Depth ......Rock Size Distance to inearest: Well .........................................Foundation .................... Prop. line ..........----------- REPAIR/ADDITION(Frau. Sanitation k:'Perm It Permit# ......__--r--------=_-�------------------- Date ----------------------------------) r' � ,` Septic Tank (Specify Requirements). ........... -.. ..... ..... .. .. Disposal Field (Specify R uirements) -••- -- -•- - ---------- -. `t .. ..................... -------- -- - ----- ............................................. .............................. ............ -..3. ° - ------- -.-- -•----•- . --- --- --•- -- ._....... • . •... (Ora 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, andRules and Regulations of the San Joaquin Local Health:Dlstrict. Horse owner or licen- sed agents signature certifies the fallowing: "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 bsn ct to or an's Compen at' ws of Signe ._._`b_ _.._ By --------------- -------------------------•------------ Title _... ......................... (If other than owner) - R FOR DEPARTMENT S O LY .- APPLICATION ACCEPTED BY ----- ---••----L� - ------ -------- ------ DATE ....�4.:r� �� 5. BUILDING PERMIT ISSUED ------------------------ ................ -- ------ - ------ ........DATE ----------- ---- ADDITIONAL COMMENTS -------------- -------------------------- ----•----•-•-•------------ -----61-1----------------------------- ----------------............................... .._. ------------------ -- ----------------------------.---------------------------------._....--------•-----. ---------------•---------....... -•--•- ---------------------------------- :... ... --- - . -•----.... ....................... G' Final Inspection by: ......... .. . .. :, � �-f-r-t-'•�.,...-----•--....------._.-...---......_..._pate ��"_'�: ..... . ..-. EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3M