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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...................................................... (Complete In Triplicate) :.......:...... Date Issued This Permit Expires 1 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. h s pp T i application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:. F JOB ADDRESS/LOCATION ......_...�:��..�.�............................. .CENSUS TRACT hone ........ Owner's Name Address ... .:2.lJ r�7.'` .�..._._..� .........City _.......................I..............._............ P--LAX. ....... hone .............................. Contractor's Name ..----- ..... - - _.......... �— Installation will serve: Residence Apartment House Commercial[]Trailer Court 0 sMotel ❑Other ............................................ y Number of bedrooms Garbage Grinder Lot Size Number of living units:............ ............ ....----........ ............... Water Supply: Public System and name..--:-- -- .. . c............................. Private Character of soil to a depth of 3 felt: Sand❑. Silt❑ Clay [-] Peat❑ Sandy Loam❑ Clay loam❑ W " I I Hardpan Adobe❑ FIN Material If yes,type............... ............ IPlot plan, showing size of lot, location of system in.relation to wells,-buildings;eft. must be placed on reverse side.) NEW INSTALLATION: INo septicitank or seepage pit .permitted if public sewer is available within 200 feet,) E ' Li vial Depth PACKAGE TREATMENT [ ] SEPTIC TANK I.] size......:...............:.... :..:.._:.... q. p Capacity;-�------- •---------- Type -------------------- Material..................:... 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 ..........................................'i I,-_4 Pro er Line --•-' Distance to nearest: Well .---........I.........__. Foundation ....................... p ty I SEEPAGE PIT �[ } Depth - - - -------------- Diameter ----_--------- Number ..=..--- ............... .. Rack Filled Yea ❑ No Q • \'nU ` Rock Size Water-Table Depth � ................................. % Distance to nearest: Well -----------............=......... Foundation-�._.........I...... Prop. Line ................. o I - Date ... REPAIR/ADDITION(Prev. Sanitation Permit# _-------- --------------------------- •-- _..... .. .. .................... •.... Septic Tank tSpecify Requi(emen ts).-------- .................................:•---...._._..Y I� ...--- •---•- . .....---•- " ..... ------- r Disposal Field (Specify Requirements) .Z7 �'' � - s © =--- .. -� -• ---- -------------- - :. ••--------------- 4 (Draw existing and required addition on reverse side ' I hereby certify that 1 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 HeaHh.Gistric.- Home owner or licen- sed agents signature certifies the following: arson In such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any-p as to became subject to Workman`s Compensation laws of California." - --- -- -- -------------•----- Owner r Sinned ---- - -•....................•------•• ---• - - - -- . - �'itle .. .---- ----------- ------ ..... --- ----- f ----------- --- --- (If other than owned FOR DEPARTMENT USE ONLY DATE ;7 ............: APPLICATION ACCEPTED BY _.. '.. _..__,. BUILDING PERMIT ISSUED - ------------- �- -- -----_ DATE ..._.._ ADDITIONALCOMMENTS --------- --------------------•----------• ------------...............----....---••-.. ... --------- ..__......_....-------=---•------..._....,.._..... ----- ---•----------- ---------------------------------------------..------------------------------------ __._.. _._... _._.._.... Date .. ..�f 2�.. •-----•-- --- _ _. Final Inspection by; .- -.--�-- ---.---:.___-------..................................... EH 13 21t J_--68 lay. 5M ( AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M