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J. 7/ �o( / 5 FOR QFFICE USE- APPLICATION FOR SANITATION PERMIT7/—//7y b 30 �y-�o 3 (Complete in Triplicate) S J Permit No. ..................... .. 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: JOB ADDRESS/LOC ON .. ----......_ .L c h .............CENSUS TRACT _..-•---------_-........: � •. / Owner's Name ----... ... 2,.- .. ....................Phone .9,9/..77- 7 Oz"...... .. .- Address . --.. .:n.`�d��.-...T7 -.t - ------ --------•... city Ur, f.4r .. x........-................... Contractor's Name .-Di ..................License # ... -..-.--.---- Phone Installation will serve: Residence Apartment House,❑ Commercial [-]Trailer Court ❑ Motel ❑Other Number of livingunits:.. . . Number of bedrooms ... _Garbage Grinder ..... ...... Lot Size Water Supply: Public System and name - _...-................................ ------------------------___--------- --......---------------.Private Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam r ` Hardpan ❑ Adobe ❑ Fill Material ...... .... If yes, type ............. .............. {Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc. must be placed on reverse side.) R NEW INSTALLATION: (No septic tank or seepage pit permitted,if'public sewer is available within 200 feet,} �•3 PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---------.. ------------.. .......... .. Liquid Depth ...---.----- .._------- Capacity . --. - Type -------....._ Material.---.- . .'k ...... No. Compartments ---------------------- Distance to nearest: Well ....... ... _---------------Foundation ....-..--.._.......-.. Prop. Line .._...._ ............ LEACHING LINE [ ] No. of Lines Length of each line ...... .... Total Length ............................ 'D' Box Type Filter'Material --------..-'*-."Depth Filter Material .._ ... ........__............... Distance to nearest: Well .-.1 .- _._- Foundation .�..........._... ... Property Line ........................ SEEPAGE PIT { ] Depth .._. .. Diametert ...............! Number. ------------- Rock Filled Yes ❑ No I❑ Water Table Depth .---------------- ----------................Rock Size _ _ ...... -..-......... Distance to nearest: Well .............. _.-.-----------------Foundation .....-- . .....-- Prop. Line ----------........_--• REPAIR/ADDITION(Prev. Sanitation Permit ... ... ........ :::: ............ Date - ---- ^ --- --....- ) Septic Tank (Specify Requirements) ..,.� -----•- Dis osol Field {Specify Requirements} .� .... Xl _ ...... ..:. '-Q ,-. .. r d- -a......... . /O X./0---....--- .. �..l� {Draw existing and require ddition on reverse side) I hereby certify that I have prepared this application and that the work will bel done in accordance with Son Joaquin County Ordinances, State laws, and Rules and Regulations of the Son Joaquin Lotal 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 subi to Workman's ompensation aws of California."Signed 1 s a t . By . - . ...-----•. .. Title ....... .. # (If other than owner) F R DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY . . - _.. DATE -/�/✓l.�) ;�............... BUILDING PERMIT ISSUED ... . . . .... . -- --- . ... . ._ ............. ..DATE . . .... .............. ADDITIONAL COMMENTS .- .------- ----------------------- --- -------- Final Inspection by, .. ..--------- .........--.Date ..f..-2- ...7-.. .-... •----- a..- SAN JOAQUIN LOCAL HEALTH DISTRICT a E. H.13 24 1'-'68E• 24 •'68 Rev. 5M - 7/72 3 ,14