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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT icomplete in Triplicate) Permit NO:..................... .................•--......._ p Date Issued ..�:... 7. -•............... ---...-. This Permit Ex )res 1 Year lrrom Date lssaed ...... 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 ....ee r--••--•.....................•---.........................CIwNSUS TRAC!' Owner's NAme .............. / ..Phone ../2./��:. � Address City ... ................... Contractor's Name `` �..__._�..._ _ ... .. :. ..License �` Phone � i4_�� Installation will serve: Residence JX Apartment House Commercial❑Trailer Court ❑ Motel ❑Other _.. Number of living units:-..--I------ Number of bedrooms ...Garbage Grinder ....... .._ Lot SizLJ ../-_ � ---- - Water Supply: Public System and name ----------- _ •------------------------•---------•- ... r Private ❑ Character of soil too depth of 3 feet: Sand❑ SIRE] Clay ❑ Peat Sandy Loam fl Clay Loam Hardpan❑ Adobe P- 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 -------- ........... Type ............. ------ Material-------•-_ ----- No. Compartments .............W Distance to nearest: Well ------------------------------------Foundation ...................... Prop. Line ...................... LEACHING LINE [ J No. of lines -..-----_---------__- Length of each line............................ Total Length 'D' Box ............ Type Filter Material ....................Depth Filter Material Distance to nearest: Well ----------••--••-- Foundation .............. •__...... Property Line ...... SEEPAGE PIT [ l Depth ------ ------ ----- Diameter ..... ---------- Number __---. ------_....__ ...... Rock Filled Yes ❑ No ❑O Water Table Depth ..............•.................................Rock Size Distance to nearest: Well ............................... Foundation . Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit r# ................. Date Septic Tank (Specify Requirements) t Disposal Field pecif Requireinentx} -- -- � -3-.`.`� ......................................... -----•--._.........._.....----•--•---- {Draw exi ing a d required addition on reverse side) I hereby certify that 1 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, 1 shall not employ any person in such manner as to become subject t rkman's Compe ati laws 4 California. Signed -.. Y .` --�- Owner BY - --- -- •--------- title _... ------------------......... (if other than owner) FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY------ --. ............. _ ._.. DATE ? , BUILDING PERMIT ISSUED ------------------ - -• -•- --•-•-- ---------------------------------------------------DATE ... _ ADDITIONAL COMMENTS ------- - --------- ------------------- -- .......... ... ...... ..........................*...__....._.._._._....... Final Inspection by_ ____________ •---• ......... -------- -•--•----•------ ............ EH �3 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M