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FOR OFFICE USE: /l•0 APPLICATION FOR SANITA'T'ION PERMIT � - Permit No. .........�_........... (Complete in Triplicate) ' Date Issued .....: ...:...� ................................................ This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein e described. This application is made in compliance with`County Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCAT N �.� .... .... ,l.C[��.. "..................................CENSUS TRACT Owner's Name �C.1.....:.... . : ......_...� w_ .'...� .PhoneY7...1�...................... Address .... ............ ...... ..........'City .....' /.. ......:..:..:..... ....... .... Contractor's Name ......(-'R .C�...SO /4e.......,1, .......License # Phone Installation will serve: Residence[] Apartment House 9Kommercial :❑Traller Court C ' Motel ❑Other ..:..................••. .................. Number of living units:............ Number of bedrooms ....Garbage.Grinder.___.._ ..... Lot Size............................................. Water Supply: Public System and name ..�� Q4:....--' ............................................................. ------Private ❑ , Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam'❑ Hardpan ❑ Adobe 2<Fill Maternal::.....:..�Ifyes,-type ....................... (Plot plan, showing size of lot, location ofsystem iW relatlon' to wells, buildings, etc.. must be placed .on reverse side.I NEW INSTALLATION: INo septic tank or-seepage pit permitted If public sewer is available within 200 feet,)- PACKAGE TREATMENT ( I SEPTIC TANK I j Size------------------------------------------------ Liquid Depth .......................... , Capacity ............. r, •-•---. No. Compartments ..TYpeMaterial:...... ...... Distance ..... to nearest: Well ........ ....... Foundation ..._-_- .:_.-- Prop Line LEACHING LINE [ ] No. of Lines . ................ Len9t 'of each line�----•-•-------------..._... Total,Len th -----._.... J - �• D' Box Type Filter Material .Depth Filter Material" ................. .................. Distance to nearest: WellFoundation- ..._......_. .._. Property Line ' SEEPAGE PIT [ j Depth Diameter .....:.......... Number ......................:>...... Rock.Filled Yes ❑ No ❑e Water Table;Depth • � .........Rock Size Distance to nearest: Well .....................................Foundation .................... Prop. Line REPAIR/ADDITION{Prev. Sanitation Permit# ............................................ Date T Septic Tank (Specify Requirements) ...................... --------------- Disposal ----•--- -- _..... ...:. Dis osal Field S eci Requirements) .Q.S' Y_ /ItV'..... �` P p fY q 1 7 �. �t.. ......... "..... l.r ..... ............ ........... ........................................................ ......... - 4 .......................................................... ................................................--..-----_•-•-•'----------------------- (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 Son Joaquin local HealfW District. flame owner or licen- sed agents signature certifies the following: t "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner i as to become subject to Workman's Compensation Signed .......... .. .. .•.... .............................`................... Owner 8Y - - Title : (If other than owner) ' FA DEPARTME T USE ONLY APPLICATION ACCEPTED BY -- - -------------------- --•--•----•--•.. ...... ....:............................... DATE ............ .... .•�•-- ...----•---- BUILDING PERMIT ISSUED ................................:.. = :...:....DATE _... ... .._........_......_..... ADDITIONAL COMMENTS .............................................----....--••• -•-•------••.............:------ --..... ................................:......................... .. ...................?A ..... ........................ ... ...................... ......... .................................... :....:.:............ ..... -- .........-................:.... ..... ........ -•--•-•• ---••- . ---------•--..... ._._............----....:.:............: Final Inspection by Date . . ..... . � ..SAN, JO QUIN LOCAL'. HEALTH DISTRICT . . E. H. 13 241-'68 Rev. 5M 7/72 3•M