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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 4COmplete In Triplicate] Permit Na. ......:_•............ .............................................. 4 .,� This Permit Expires 1 Year From Date Issued Date lssued .....�.:.7.� 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/LOCATION ; . _.. ...............................CENSUS TR..ACT. _ ----•----• •-••-••---•�. -- ----------- *...... Owner's Name ---- . ............................Phone ..._ Address .......... ...• --..._........... City ............. dzr Contractor's Name ---.-•'".' ---- ------------ -•--......................License # ........................ Phone .............................. Installation will serve: Residence®'Apartment House f:] Commercial❑Trailer Court 7 7-60'46� Motel ❑Other............2_4_ e All ...... Number of living units------------- Number of bedrooms ---- ...Garbage Grinder �-. . ...s � � �"............ Water Supply: Public System and name _.....-----•--••-•----•.................•-•--...------..-_....................__..._------....................Private,® Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan 0 Adobe 0 Fill Material ............ If 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT F ] SEPTIC TANK' Size. ............................................. Liquid. Depth ....... 04 Ca.pacitY ,- ------ Type No.No. Compartments ----. ...f......_ V� Distance to nearest: Well _______�_ Q....................Foundation ...... ......... Prop. L€ne ....,3..d............ LEACHING LINE No. of Lines I Total Length --/- ----------------- Length of each line...------------------..._ Length ... � 'D' Box ...... .. Type Filter Material SSr°R&PK `Depth Filter Material ...... ...................... Distance to nearest: Well . _ Foundation r ----�--�2 ..-��--_-__-. Property Line ..._,�0_._ SEEPAGE PIT { j Depth ----------------_-- Diameter ......... ...... Number ........._____..-----....._. Rock Filled Yes ❑ No 0 0 Water Table Depth ------------ -•----. ............... ---........Rock Size ................................ Distance to nearest: Well ....................................... Foundation -------- ----------- Prop. Line ... .................. REPAIR/ADDITION(Prev. Sanitation Permit# ..............................f------------- Date .................................. Septic Tank (Specify Requirements( ------ •_..... ..................... . ..................................................... .... Disposal Field. (Specify Requirements) --------------------------------------------------- --- -------------------.----------------------------------------______________ _________________________.......................................................... {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 Regulations of the San Joaquin 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 manner as to become subject to Workman's Compensation aws of California." Signed ------ -- --- Owner By ...... ----------------------------- ---------------• Title ----------- ........ Ilf other than owner) R I$PARTMENT USE ONLY APPLICATION ACCEPTED BY ....... -- °l' DATE ..., �� 77.... = BUILDINGPERMIT ISSUED ---------------------_--------- ...... •--•- ...............................I—..............DATE ---_.._.. _._...-----.......-----.---••--- ADDITIONAL COMMENTS ----------------...........................-•............• .................................................. ......... .. -- ---•- -- --------------------•-•-•---•-•- .-------•----•- --- ---------• -------------------- ----.. Final Inspection by: ___ _ E:__. . _ .. ..-_Date _..._ .. .-- EH 13 24 1-68 S JOAQUIN LOCAL HEALTH DISTRICT 1