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- i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ...................................• .............. Permit No. _..�-3.:........ (Complete in Triplicate) j 3 , . P Date Issued ./ ....:.............. ..........-........__..., ear From Date Issued • This Permit Expires 1-Y 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 Na. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION CENSUS TRACT .......................... Owner's Name _-- ...............Phone, ----------- - -->-- ._.._. __�}_Ott=}_S... ..........._._....-................... Address .. `7:. ...... "'' "' _....... City ....1..F'P - , 1,.... ..................... Contractor's Name _...... ,.A.... 4s�&-_11f--- --..License # ��.:�.y��. Phone F Installation will serve: Residence Apartment House,❑ Commercial ❑Trailer Court 0 � Motel ❑ Other .:_:_:.._....-----••• - Number .of living units:.... .:..: Number of bedrooms -.7 .__-Garbage Grinder Lot Size ►..t.................. Water'Supply: Public System and name ....................................... ...I._......-,.._._.....................................................Private [ Character of soil to a depth of 3 feet: Sand TV Silt❑ ~ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobe ❑ Fill Material ----- If -S, type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 5 NEW INSTALLATION: (No septic tonk or seepage.pit permitted if public sewer is available within 200 feet,J PACKAGE TREATMENT } SEPTIC TANK j j Size.............--------- .......-.........:_`...._ Liquid Depth ..........................C41 t Capacity .. _. ..-, ..... Type ------.- .._..._ Materiafi_ _- ;_r`.. ,-Y.No. Compartments ..................... 4 , w , Distance to nearest: Well .*T.._...... ...:.................Foundation ......-----------...._ Prop. Line ..................._U1 LEACHING LINE [ No, of Lines Length of each line .... ................ Total Length L 'D' Box .._....... . Type Filter Material ....................Depth Filter Material ........................... 9 Distance to nearest: Well ........................ Foundation ....... Property Property Line ................... SEEPAGE PIT [ } Depth .. ... ......... Diameter ................ Number , ...._._..:.. Rock Filled Yes ❑ No Water Table Depth .. .---------------------•----_..Rock Size _....• - - _..:--------- ------ 1 Distance to nearest: Well -•--------- ----------------Foundation ............_...... Prop. Line .._... ............. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------- ................... Date .................................. Septic Tank (Specify Requirements) :.. --...4-�pA----- r .... Disposal Field (Specify Requirements) ......... ------- . .... ............................ ..........•-.... .- ----•- -•--- .-•-------------- . . :---...............-----._...-- . ....-. ----- _...-- ..... .... _6..&an, ..� (Draw existinguired addition on reverse side} I hereby certify that.t have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State lawn and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i "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 Workman's Compensation laws of California." Signed . - ...... ...•................... ..--------.....----------.... Owner By .__ title (if other than owner) FOR PEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ..---- ----....... DATE .-r2..:` '.7-3........ ... I BUILDING PERMIT ISSUED ._...._. ......... ....... . _.._...---••----...... ............DATE ,..._................... ............ ADDITIONAL COMMENTS _...... ------------------------- -------------- .... -- - --------------------------------- ....---•---•-•-•--- Final Inspection by: .... --- --- •---------- --- --------------- •-- ---- -_ --------- ....................... Date --- �-% Z�, j SAN JOAQUIN LO AL ,HEALTH .DISTRICT E. H. 13 24 1.'68 Rev. 5M 7/72 3 .K ,