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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..................... Permit No. ...ry (Complete in Triplicate) -------------------------------- ------ //- .............. / ---------------- ---- ------------------ This Permit Expires I Year From Date Issued Date Issued ..4......... .._.. 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 Coun Yrinance Na. 549 and existing Rules and Regulations: JOB AQDRESS/LOCATI "....c .. 7 -��........ . ... ..f_ ....--------- !.....--...._......._..............CENSUS TRACT .............. Owner's Name ... . .. ........ .. Q --=-•- hone Address -o _.J�-. _-. .. . _.. City ...... ------•- ._. E .. GG- Contractor's Name .--- • ----- ------- -- ----------- ............... ._.. --.....License # ,Per l..y Phone ...---------.._.__.._......... Installation will serve: Resider Apartment House 0 Corpr e�rcialC]Trailer Court 0 Mote! ❑Other -- .. . .. ......... .. .................. Number of living units--------- Number of bedrooms __Y..Garbage Grinder ..-..--_--- Lot Size ..4—ore ��-�.,...f........ Water Supply: Public System and name .---- - Private [J Character of soil to a depth of 3 feet: Sand eAdobe t- - Clay_0 _ Peat 0 _ Sandy-Loam 0 Clay Loam - Hardpan 'E] Fill Material ............ If yes,type ----------------------- (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is availapie within 700 feet.) TREATMENT f PACKAGE TREATMENT ( } SEPTIC TAMC f Size. p .7 .X.�....... Liquid Depth Y..............•---- Capacity .J :oa... .... Typ �:c&.2�... Material.-r. ..._ No. Compartments ..��'�,........... Distance to neorlt: Well ........,.1�C? .__. Foundation - Prop. Line .. ................ LEACHING LINELines of No.]� [ •------I--------------- Length each line.-....... Tota! Length ......1-_ate D' Box Type Filter Material Depth Filte l g `' P_*Ic Distance • to neores : Well ....-J�` .. _._ __._ F�°undotion ...... . .. ... .. Property Line __!� . _._...... SEEPAGE PIT [ Depth --- _ Diamete ...,a .`IVumber ....-- l.__ Rock Filled Yes No ❑-'� Water Table Depth .......__... Rock Size �, ..., . Distance to nearest: Well K.. ......Foundation -------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit+# --------------------------------------------- Date ..................................) T SepticTank (Specify Requirements) ---------------------.---------......--.._...........-...-...... ................•......................................................... Disposal Field (Specify Requirements) -------•-•-- •--------•.............•-•-••---...........--...._.------ •------------------------_--- ----------------------------------------------------------------------------------------------------------------------......................_..I—------------------------------------------------------ (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 Son Joaquin local Health District. Horne 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 subject to orkman s Compensatio_pAqws of California. Signed ..................... ------------ --- ----- .-... --- ------- -• --- - Owner By ..................(I .._- . r . ....... - ..... Title - (If oth r than owner) FOR DEPARvTMENT USE ONLY APPLICATION ACCEPTED BY ...- - - ....... ... ........•................................................. DATE , 2... .� BUILDING PERMIT ISSUED . ......--- ................ ----- -------------------------•-----------....----------••----------•--•--..__...............--- ......DATE ADDITIONALCOMMENTS ------•......................•---•-•--------••--•---•--------•-•..............................-•-•--........----•- .-.-.....-------=-_----------•............ ... ........... .........Inspection by.. --r....................•........--- .............................. Date -.......� 6 .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1-3 24 j•'bg Rev. 5M 7/72 3 M