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FOR OFFICE USE: ? APPLICATION FOR SANITATION PERMIT ` + .:............................1-------_---._.- (Complete In Triplicate) Permit No. .. ............ .............................m-.......... - ......................................................... This Permit Expires 1 Year from Duh issued Dote 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/LOCATION -- .....�f.��`S � -- - . ....... ..... ......................CENSUS TRACT .......................... ,( T f .. ..... - Owner's Name _ !`z!9:�✓[1..... .G./�l.�elG�i ..11......... ............................ Address1. ... City`�?7i71t/ -.. _ .. Contractor's Name __.__. ..License sa.V .LPI-Or.r.. Phone .Rr3 Installation will serve: Residence ❑Apartment House❑ Commercial❑frailer Court ❑ Motel ❑Other ............................................ Number of living units:-/------- 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 [❑ Hardpan ❑ Adobe 0 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) PACKAGE TREATMENT f ] SEPTIC TANK{ ] Size......... .............................. ...... Liquid Depth .......................... Capacity -------------------- Type .................... oterial.................. _.. No. Compartments ..................... OQ Distance to nearest: Well ................... ...............Foundat' n ...................... Prop. Line ...................... LEACHING LINE ( ] No. of lines -----•------------------ Length each line........ .................. Total Length ............................ 'D' Box ------.._... Type Filter Materi ------..............D th Filter Material ............................................ N Distance to nearest; Well .......... ............. Founda on ---..._----------------- Property Line ............ SEEPAGE PIT ( 3 Depth -------------------- Diamete ................ Nu er ..__..---_-._.---.--.--. Rock Filled Yes ❑ No ❑ Water Table Depth -.--_---- •----------------- ------ .........Rock Size .......................... ... oI, e Distance to nearest: Well ........................ ...... .......Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit'# .. ........................ ................ Date ......................-...........) D Septic Tank (Specify Requirements) ..............•---......_.............................. ................._..-•........ ---• ... ........................... Disposal Field (Sp city Requirements) -----)-9If1 ......... ;72-- ------ ----------- -- . ------------- ---------•----------------------------................--•..................................................................... ------------------------------------- ........................-------------.......... ----------------------..............-.................•-- ..................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work 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: "1 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 #oorkma Compensation laws California." Signed --- ----.. -- -----J.... .......... ------ --- Owner BY '4 ---------` ----- ------------•---------------•-•--- -Title .......... ----------- .......... If other than owner} NL FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS© BY - DATE . ....-. . BUILDING PERMIT ISSUED -- -------•-- DATE ... ADDITIONAL COMMENTS -.- - - ---- .............. ............. ---...------•. -- ------------------ ......................... .......----- -- - ------------------ ........... --------1-----...----------------- •-----.----- -- ----...--. •---------- --•.......... ... . ---.... . . ---.......-_... . _. _ .. Final inspection by: .-------- ------• ..........................•-•-------- ....................... �S_....... EM 13 2h 1-68 Lev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M