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FOR OFFI USE- APPLICATION FOR SANITATION PERMIT ............ . . --.-- c 7� ,� (Complete in Triplicate) Permit No. .. ............... ----------------- .........-•-----••---•-•----• �.7L h This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Hea istrict for a permit to construct and Instal the work herein described. This application is made in compli=141Z aunt O divan No�9 and i�c jnLg�,Rul� d e ulotions: JOB ADDRESS/LO IO .l.s 1.9,. .. ......................e.-CENSUs T ..... Owner's Name . Phone .. � E_�f7 ..... Address �/. .1� City . .. ---------- ........ ................. Contractor's Nome .k �.._ ..!�._. 1-.....License # ........................ Phone ... Installation will serve: Residence E�rAjpartment House E] Commercial❑Tra€ler Court a Motel ❑Other...........................•-•---•-•-•-••••- Number of living units:------- Number of bedrooms:�_...Garbage Grinder ............ Lot Size . .... .... .. .... Water Supply: Public System and name .................. ....................................._-...................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam j?_ Hardpan—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 [ ] SEPTIC TANK ] Size................................................ Liquid Depth .......................... Capacity -----------•-------- Tyle -------------------- Material.--------------------- No. Compartments ..................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..__..__.............6 LEACHING LINE [ ] No. of Lines ------------------------ Length of each line--------------------........ Total Length _........_............_....W 'D' Box ..------.-.- Type Filter Material ....................Depth Filter Material ............. ------------------------------ Distance to nearest: Well ------------------------ Foundation --------................ Property Line ........................ SEEPAGE PIT [ ] Depth -------------------- Diameter ...•------------ Number ............................ Rock Filled Yes ❑ No ❑C Water Table Depth ................................................Rock Size .........---- --•-•-•-• ....... Distance to nearest: Well .............Foundation ............-- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ..........................................-- Date ----------------------------------) Septic Tank (Specify Requirements) ---�-- --- ---- -- ......... .............k. j Disposal Field (Specify Re ui erne s} __ - ....--...._---------------- - -- - - c� I �_ ------------------------------ (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:Dlstrict. Home owner or licen- sed agents signature certifies the following: "I certify that in thepettformance of the work for which this permit is issued, I shall not employ any person in such manner as to beapnw su kec�ti kma 's Com sation laws California." Signed 5.! Qwrer .... .---• Title " .. (if other than owner) R 4PARTMMY USE ONLY APPLICATION ACCEPTED BY .---- - - - - -- .-C- -11 --..... DATE"' -..� -... ...--••--. BUILDING PERMIT ISSUED _-._- .... DATE ��^�� ------------------------------ .--- ..................... .-------------------- ADDITIONALCOMMENTS ------------------------------------- ----•---•. ----•------------------------ ................ --------------------------------------------- ..........•----------- -----------------------------------------•--------....----------------- -------------------- ----------....--------------------------....--........... -----------------------------------------_..- ------------------ ----------------------------------------------------------------------------------------------------------- . .... Final Inspection by: -------------- - .----------------------Date"� .. EH 13 24 1-68 ilev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M