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FOR OFFICE USE: + h.---......I................ _.. APPLICATION FOR SANITATION PERMIT Permit No. ..'7�_� � (Complete in Triplicate) ......................................I........... ..._. ......................................... This Permit Expires i Year From Dale Issuers Date Issued I� 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: rye JOB ADDRI=55%LOCATION :..:......... ..: /•• �.._:... �..,t..... `'` `._._..............CENSUS TRACT .:.........--- Owner's Name .................� � , .......... _..•------•.................._......, ---.......__...:...P one Address //� �� `� � ` Lf� i . ? Cityh .........................-_........_. { ............. Contractor's Name ....... .............�...:....... ................License Phone Installation will serve: Residence Apartment House Commercial :QTrailer Court ;Motel ❑Other .... 4/ t Number of living units:.. Number of.bedrooms . ....,..Garbage.Grinder.,._._...._.... Lot Slze .f mow__ -............... Water Supply: Public System and name .............• -------------- ---_- . ---........................ ................................. ° Character of soil to a depth of 3 feet: .Sand 0—. Silt-0 Clay 0 Peat-C) —Sandy-Loam Ur —Cloy Loam ❑ . Hardpan ❑ Adobe'❑ Fill Material _...__. .... If yes,type -_---_-.---------- ------- (Plat plan, showing size of lot, location of. system inreiation to; wells, buildings, etc: must be placed,on reverse side'.) NEW INSTALLATION: (No septic tankior seepage pit permitted if public sewer is available within 200 feet) J PACKAGE TREATMENT { ] SEPTIC TANK{ 1 Size....V_n_.'1. .................. Liquid Deptk .... ? .1``........... J Capacity M�'.----• Type P&& 95 Material----•................. No. Compartments ............. Distance to nearest. Well .----�?..P......................i_.Foundation ............. Prop. Line ..-5.......-.......... LEACHING LINE [ 3 No. of Lines _.�___________ .... Length of each line.:� '�.__.. Total--Length-l..�` . ._.-.......... f � 'D' Box _ _.__.f Type Filter Material /Depthl Filter Material ......./_g ................ Distance to nearest:Well:. ...---•-_.._..__.,___: Foundation .... ......._ Property Line Z-.01............... SEEPAGE PIT Depth# ------ Diameter . .... .�::: Number-.-..-.-'?a.................... Rock Filled 4Yes ❑ No Q Water Table Depth_--- -••. ..............................Rock Size .............................. a Distance to'nearest: " � Well ...............................•' Foundc—tio:n ..--=--.-r-..-.__•.-....y-.-.-:JProp aLi.ne .................... REPAIR/ADDITION IPrev. Sanitation Permit # ......-------•----•• •...I...... Date . . f - Septic Tank (Specify Requirements) ..:------`i.... ' ......!.................. i P (Specify Requirements) .. --------- ................... Disposal Field ed uirem IS Re "lI t _____________________________ __ _ _________•_______i____..__.:._._...___...__________._...._F._...._..____......._-______..........__..__.__...................................................... (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 Regula#ioris oT`the San Jbagpin 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 mannef as to become subject to Work k a 's Compensalton laws of California." , Signed .. :... ........................... Owner , BY ...1 _. " .... ,_r ................................title (!f other than owner) FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY .. -_...�._. ...........I................ .................. DATE _ .... :_...._.....,, ---------- BUILDING-PERMIT-ISSUED-:.-:,.-. •: —----- --- -- -. — DATEn.=........ ...... ..................... ADDITIONAL COMMENTS . . --------------------------•..._-..------._-_.._.__..................... ........:. ..................I—. ••-•- ........................-.:_..,_..--•••••-•..... ........��..`.. ...... .....i` ................................................... _ .... ,_ ,�+� •----• --•---- Final Inspection by: ...:........:. :. ... •--•-•-•--....--•- ate �J.... D dr_`. ' SAN JOAQUIN L LOCAL HEALTH DISTRICT E_..y 13 241.'68 Rev. 5M A167/72 3 M