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-FOR OFFICE USE: APPLICAT16k FOw SANITATION PERMIT (Complete in Triplicate) Permit No. .1 .:..:. 1.... ........................................ ........ .............................................. 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 crud install the work herein described. This application is made in compliance with County Ordinance No, 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....... ------- ....CENSUS TRACT .......................... Owner's Name ...... e .......................�....................... Phone .��n. -r��.��... ...---•----- •--- ....... ._ lAddress . ........_ ay. --_.... -- ----------_ _..--•---... City .......... . --- Contractor's Name .. ,. .(..._ r ZGG...�-------•----.............. .......License # .0 '5= .c _ Phone Installation will serve: Residence V Apartment House•❑ Commercial ❑Troller Court 0 Motel n Other ........................... A � G Number of living units:-- /...... Number of bedrooms ,._....Garbage Grinder _. .. ... . Lot Size .... ......................................104 Water Supply: Public System and name ... ---•-----------•---•------------------•---• ---- ........................................................Private Ig 14 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [�Y Clay Loam ❑ '� 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size... LiquidDepth Capacity��Cr� __ . Type R.r2EC <FMateriai......._. .. No. Compartments __- -.._......-. Distance to nearest: Well .��1,2. .. ..................Foundation gip.__.___._.._._.. Prop. Line __��.0 ....._.... LEACHING LIFE [ ] No. of Lines . 3 Length of each line ._ld_*-...-.._...-- Total Length .a.' .............. 'D' Box ..� Type Filter Material _ ,+��1 -.Depth Filter Material __.��'_. �-------------------------- I .� Distance to nearest: Well _.�p�........_.._.... Foundation �d -- ------ Property Line _.�j................� SEEPAGE PIT [ ] Depth ...... Diameter ................ Number .... . ....... ...... Rock Filled Yes ❑ No C1 Water Table Depth ------..........................----------------Rock Size .....--------------------------- Distance --------- -------Distance to nearest: Well .--.....................................Foundation ............ ....... Prop. line .--•---._ ---.-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---- ----•--- ----- ------ Date ---------------------------------1 - a Septic Tank (Specify Requirements) ._._ .................. ..... ------- --------------------------------- ------•---..._..-------- .......... ................ Disposal Field (Specify Requirements) --------------------- -------- ...... .............---.r_.......................... ._.. --•. ........ ........... .................. .......... ..................................................... (Draw 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, and Rules and Regulations of the San Joaquin Local Health District. Homs owner or licew sed agents signature certifies the following: "I certify that in the performance of the work for which this-permit is issued, 1 shall 'not employ any person in such manner as to become subje to kma ' Com nsation laws of California." . Signed .:�j�f ..r... _. ... ----- Owner ,1, J0 By . ............ ........... •....................... .. ......... --------- , .._ Title . f;. :%.. ............... (If other than owner) ' AlFOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY . ................ ... .. . .... ......... .. ........... DATE 3.... . BUILDING PERMIT ISSUED ... .. . ................-....-...._-: ._..--------•..---........._..........._.... ... .. ........ _ ._........-- .............._..... ADDITIONALCOMMENTS -------------- ---- ---• ------------..........--------.....--•-------- ---....-- .... .-- .-----..-................... .-----•- ----------------•-------...---- ------------ . --- --------- •--------.......... -------------------------------- Final Inspection by: ..._., .._. . .- --•_ -- Date .... : : ._ ......... .... __ . .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'b8 Rev. 5M . 7/72 3 kI