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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��y catel Permit No. .�.... _.- •••--- (Complete in Yri lr • p p ' ...................................•........:.---_..._.. This Permit Expires 1 Year From Date Issued DateIssued -/d�30: 75 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: r JOB ADDRESS/LOCAT ON ._. , -- 01-p----..... ' ..-._- -..CENSUS TRACT :...:'.................:.. Owner's Nome ........ . °------ 4- ... .............. ...Phone .........................:.......... Address -........ _._ .. . .............. cit _ .- - ---.....- ..............----�-•-f---�.................... Contractor's Name . t.� ��' °`�_. ..-----.License ,# vaj�_ l�f_ _ Phone Installation will serve: Residence WApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ........ .............. Number of living units:...:..,_. Number of ed(ooms . .-------- Grinder ._'&... Lot Size .,� sr-..�-_.. .., .. ....., Water Supply: Public System and name ... _ .----- �- - .......Private Character of soil.to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT [ ] SEPTIC TANKSize. _ _' t Liquid Depth .. ..................... Ln Capocityf.J40.&(k Type Material_. . No. Compartments .. ......... Distance to nearest: Well _/- .-----Foundation ./!1_..f._...... Prop. Line .__ `.�_ ------ rn LEACHING LINE P4 No. of Lines ._ .._. Length of each line .. d ......_....... Total Length /..a?�._f.............. C. 'D' Box o l Type Filter Material ��._..._Deplh Filter Material .:`�%_�� —' Distance to nearest: Well ..e�J.. ----------- Foundation e._f _----- - Property Line _0_'o SEEPAGE PIT Depth .oZ l__._. Diameter , __..�_. Number ..._-�47................... Rock Filled Yes �K No Q � Water Table Depth _.._... --- -- -----------Rock Size Distance to nearest: Well y -- ..-----I......__...Fovndotion _� ..`.... Prop. Line ... �....... REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------- --------------------- Date ------- ----------_.) ; Septic Tank L(Specify Requirements) ...... ..............................- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------- ....................... F (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dere in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local l4oaltlh District. Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,.1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _ .. . Owner By , .............I...... Title . (If Rotherthon owner FOR DEPARTMENT USE ONLY _ , �.O '..►�--_� APPLICATION ACCEPTED BY -1' ....................... . ..... --... ......._._.._... DATE BUILDING PERMIT ISSUED ............... .... . ..-- ... ..... ----- -- ---.................. ---..:..:.DATE ........ ...... ADDITIONAL COMMENTS ------ ------- ---- ----------- - ....._... _.__.... ........................ --.----- �-. a -- - - .---...- --........._..-----....._....._...---...._....... _............. .....__. ....... -Final Inspection by: / --. - - ------------- ----=-----• ----:..---•..---- _:._ _ Date � .._. .Z0.'.-_ SAN JOAQUIN LOCAL .HEALTH DISTRICT E._H. 3.3- 4 1-'68 Rev...5M. _ 7/7 3 ,K