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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y�pAkdmplete In Triplicate) Permit No. ...75; ..... This Permit Expires 1 Year From Date Issued Date Issued .. Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... .7 ./� _ % L.U�= ...CENSUS TRACT ..................... j s �CT...�l«Q� �= �/c Owner's Name ........... ._.._ .............��.c��__....._._.�__..11�..�_...-�.....__...------•------....Phone G�� ............. Address — t�f:�-�� `�' ? /11.t9✓1i�� 'Q_...-,�C..�.P--- ------------ City ��f�� Z�l- c= ---------.... Contractor's Name .._.•__ ......._._...._._. - ------.License # j � _`� Phone Installation will serve: Residence VApartment House-0 Commercial ❑Trailer Court ❑ II „Motel j]Other .............. •-•-----•-- . Number of living units:.. ..f - - Number of bedrooms .. .--__Garbage Grinder ,_... .... . Lot`Size .... . Water Supply: Public System and name .................... ................ ..l._._ Private . ,........--_-....-•------------------------------------ Character of soil to a depth of 3 feet: Sand E3 Silt E-- Clay [] Peat❑ Sandy Loam V Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 [ ] SEPTIC TANK.j ] Size----------------------------------- _ ... liquid Depth ......... ...._. 04 .-_�. Capacity .. Type --------------- Material.......... .. . .... No. Compartments ...................... Distance to nearest: Well .. ......................-------Foundation Prop. Line ..................... LEACHING LINE j ] No, of Lines Length of each line....... ...... Total Length ..........---------- 'D' ..'D' Sox ..... Type Filter Material --------------------Depth Filter Material _•__ -.._.... .........................---_-. RDistance to nearest: Well _..- ------ Foundation ........ Property Line ---------.......I....... D SEEPAGE PIT [ j Depth ........ Diameter -----------_-- Number .._......._ Rock Filled Yes ❑ No (:3 4 Water Table Depth ...---- --------------------- ...........Rock Size ......-......................... C� C Distance to nearest: Well _.------------------------:•_•;_......_.Foundation ...._........ ------_ Prop. Line ...................... 1. A REPAIR/ADDITION lPrev. Sanitation Permit# -------- ..........................-.... Date .............__-.---_-_--_-.-_.) ¢ I Septic Tank {Specify Requirements) - --- Disposcrl Field {Specify Requirements( ----- j. --O. ----1.___.__--/_/0 k .0'1 C ........................... ................. ....... ........ ------------...-........... ----- - ........ _._., vki .......................R---------------_f_ (Draw existing andrequired addition on reverse side) I hereby certify that I have prepared this application and that-the work w.iil_beone 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 orkm n's Compensation,laws of California." Signed .... ClC..c. ,.. C ........ .............-----•- _..- Owner By . - ------------------ • --------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE ..... _. ..1. . . .?�" _....._.... BUILDING PERMIT ISSUED ---- .._ _-. ...... ........ ......•-•------- -••---.............._.__....... _. ... ... ._.DATE - - -- ............-•-•.............. --� ADDITIONAL COMMENTS .... ;-.•..........-----------I-------------- ................... -- .......... ------.- ........ ..............I.... ........-- --• ................ ..................•-----.....----•-.........._... .... .........I—— ---- .... . . . Final Inspection by: ......... .... ---------------- --------...----_-------------........... Date SAN JOAQUIN LOCAL HEALTH DISTRICT a E. H. 13 241_'68 Rev. 5M 7172 3m