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FOR OFFICE USE: k APPLICATION FOR SANITATION! PERMft � ........ ---------------........... �....._-..,__.._ — permit No. .. 3:. ' k (Complete in Triplicate) ..:..... ............... ............................. i 0 7-3 .-...-:... This Permit Expires 1 Year From Date issued Date Issued ...-.......L..-..... J 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: 'd JOB ADDRlr55 LOCATION , fro 1711 ...: ..-. CENSUS TRACT .........:................ Owner'Name . ., �._. `� Phone . •r7l`- �S .. Address .....-------•------- ._._. ..�: �� ,Q L ?. ...4.�-:City . .. .. . 6...... ...... ti Contractor's Name -------------- r- ..•-- .._. '---� �._............_....License # � L.. Phone ,,. Installation will serve`' Residence XAportment House C] Commercial ❑Trailer Court 0 i • Mote( ❑Other ............................................ Number of living units_____________ Number Nu I tuber of bedrooms .___._____._Garbage Grinder ._.____._.__ Lat Size ... '�`.�. .................. Water Supply: Public System and name ........ ................................... .-.........-_...-•--- # ....................Private ❑ i Character of soil toga depth of 3 feet: Sand❑ Silt.❑'=•�-Clay ❑ Peau[] Sandy Loam`.] Clay Loam ❑ Hardpan F1adobe Fill Material ......... __._`., yes,type--- -:;.._.._............. E I -_ (Plot ;plan, showing size of lot, location of system in relation-4o wells, buildings, etc. 4nust-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( ] f Size---------:.:,..... ......... .:Y: Liquid Depth .. ..................•__-- Capacity ------- ------------ Type....................... Material-----------...........I. No. Compartments ---•. .... _ Distance to nearest Well i ..Foundation4 :.... Prop, Line -. LEACHING LINE [ ] No. of Lines`�-__ __._... .7 Length of each line_________ _ _',:__. Total Length .... : DBox Type Filter Material ....................- n Depth Filter Material Distance to-nearest: Well _ Foundation _. ' _._.: Property Line [n _. ..--- •--- ...------- SEEPAGE PIT [ Depth ...........I........ Diameter ................ Number ....__._........:...-_L_.' Rack Filled Yes [) --^--- v d i' Water Table Depth .................................Rock Size Distance to nearest: Well --.....:.:..............................Foundation ...............;_..: Prop. Line .........``......... -- REPAIR/ADDITION(Prev. Sanitation Permlt# -- ........... Date ......) Septic Tank (Specify Requirements') ............•........................... �i-�..-J.•.-- pp...__._ ..i- ...`-- --------- -•- _..- �4 - r fr .. r.......... Disposal Field (Specify Requirements) ..... ......................... k S ....-----------.._.._.-•-•- =� :.. .........................................•-......-.................................................................:...... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and thatthework 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 become subject to Workman's Compensation laws of California." Signed ...........................• .......-•• .-•-•- . - Owner . 8y ............. � .'-...'. I.... '....................................... .Title ...... ............................................. (If oth tan owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY ....... --- -,--•----------- -- - -a'r ...---•--:....._....---•----. DATE -- -- --`-'-.. .. ........ �.- ... . BUILDING PERMIT ISSUED .................1- -..................DATE --•--...----------- ---... ADDITIONAL COMMENTS ' ................................ ••. -----_- _ .............. _ ........ ... ..... Y .......... ...--• .... . ....... ----------k Final Inspection by: ..... ........ •---••---- I ...._ ..................Date ...... .. r .. SAN JOAQUIN HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3•►1S