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FOR OFFICE USE. . APPLICATION FOR SANITATION PERMIT ........`.. _ {Complete in Triplicate) Permit No. ..7�.............. This Permit Expires From Date Issued Date Issued . :1 d 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: JOB ADDRESS/LOCATIO — C�� ......�::__.Iota - ---�. _ -0tk.......................CENSUS TRACT ...................._•.... Owner's Name ............. .. . ...:�y f. !l4�*�.._ ..Phone 5,.7/�_ CZ3 ... Address --•-•---.....� ------- --- _.. .— City ......... .. . . .. .... Contractor's Name ............. ...........................License #95Y�.`f3..... Phone � � 613�... Installation will serve: Residence ❑Apartment House❑ Commercial Traller Court 0 Motel ❑Other h% ..4 .11:,:� t.. . } i r Number of living units:............ Number of bedrooms ..�:.Garbage•GrTirider ............ Lot Size YO.......... \ Water Supply: Public System and name .....................-.___-. �-- ---= • Private Character of soil to a depth of 3 feet: Sand b silt C] Clay�,10"A'i'of❑ Sandy' Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill 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: lNo septic tank or seepage pit permitted if public sewer,is available within 200 feet,) ,. PACKAGE TREATMENT ATMENT [ ] SEPTIC TANK f ] Size........................ ..................... Liquid Depth .... ..................... a Capacity' .:...:............ Type ............... Material----- - ---X- No. Compartments ...................... Distance to nearest: Well .................. ................Foundations.:`::t............... Prop. Line ...................... s �+ LEACHING LINE [ ] No. of�Lines ________________________ Length of.each line----....... `............: 'Total length ............................ 'D' Box ------._.... Type Filter Material ..................:Depth Filter Material -_.--.............................. ......_.. 1 Distance-to-nearest: Well ........................ Foundation --------------------- Property Line --...................... SEEPAGE PIT [ ) Depth Diameter .............:....Number __..__....._................ Rock Filled Yes ❑ No Q Water Table Depth --------------------------------------- ........Rock Size ................................ Distance to nearest: Well........................................Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ._......'_.........II.......n------------------- Date ............................. •� Septic Tank (Specify Requirements) ......... e,4,,DD -- .C--t'..-- o� w zncr 'I.MT"°. .._ D............. Disposal Field (Specify Requirements) -- �..•-- --•• ga.-- ---- .............. ...... ------------- I (Draw existing and required addition on reverse side) 1 hereby certify that I have preparedrthis 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. Home owner or licen- sed agents signature certifies the following: `k1 "I certify that in the performance of the work for which this permit isiissued, 1 shall not employ any person in such manner as to become subject-to Workman's Compensation laws of California." Signed ................. ------ ----- - .... -- Owner BY ............. "-..... XJK---- ......._ ...... . ........ Title .... ............ ......_................. (Ifo er n.owner) . FO �ARTMENT USE ONLY APPLICATION ACCEPTED BY .... _ DATE ..... .:. �. ; . BUILDING PERMIT ISSUED .._. .... :•- -...%.. = --• ..: -•• •----- .................. DATE ...--------...........--- ......... ADDITIONAL COMMENTS `/..... ....... .•--• ......... .. .........•-•--•• ...........-----------------------------------•------ ....................- .._ ..... •. •�....---- . •: --_ ..-. .. .' ----------------------------._................. . . ... .. .-- _ -V-� -_-- ..... .-- Final Inspection by: ........ .-- ........... ... ........................... ---•- ......................................Date .... - j. So NWJOAQUIN LOCAL. HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3 M