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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 7 7—/� Jc (Compote in Triplicate) Permit No. ..._......._.._.-. .................. ....... ._ .. - ............_......_.... .... ......................... This ParmieExptres f Year From Onto Issued Date Issued.r?.:!----j..7. ' 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 complia c wi County Ordinance No. 549 and existing Rules and Regulations, ' JOB ADDRESS/LOCATION .��. '. ..... _..._. ..... ..... ......................CENSUS TRACE .......................... Owner's Name .._..1.. _< . e_?{�ca�-l '�.ftl.. . ........:... .............Phone ......... ......_......._......... .. Address . _ _-��. _ ....... CI .................................. ........ Contractor's �........License # Zcc. Phone ..................... Installation will serve: Residence[SJ Apartment House Commercial ❑Traller Court ❑ jMotel ❑Other............... ----.....--............. Number of living units:.. ..... Number of bedrooms _.C.-.....Garbage Grinder . .......... Lot Size ..... Water Supply: Public System and name .--------------------- ..................................------ ......1...............1................. .....Private[ate Character of soil to a depth of 3 feet: Sand❑1 Silt❑ Clay ❑ Pact C] Sandy Loam C3 Clay Loom Q Hardpan U 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,) i PACKAGE TREATMENT ( ] SEPTIC TANK{ ) Size..........................................-.... Liquid Depth .......................... ) Capacity ............_ ------ Type Material-------- -----....... No. Compartments ..................:... S Distance to nearest: Well ._.. }..............Foundation ...................... Prop. Line ..................... Q ' 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 ........................S SEEPAGE PIT { ) Depth .......^_.......... Diameter .......:L. Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ...... - :..................................Rock Size ....-.......:.................. Distance to nearest: Well ........._. .......:.............Foundation . .................. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Piermit# ....:......................... ......... Date ---......... ...................... ) Septic Tank fSpecify Requirements) ' !2 Fie (Specify Requirements/)�_--- * -- - - - � ........ . ..... .... ..... ... . ............._...... .. .. ...... ..-.. - ._.._.................................... ..................._.._.............. (Dobw existing and requirbaddition on reverse side) ' I hereby certify that 1'have prepared this application and that the work will be done in accordance with Son 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 Workman's Compensation laws of California." ' Signed .... ..............._ .... - .... Owner By .... .........._..........._..:.._......... .. ....:. ....- .. .. Title . �Ae-? �G�h._...._.... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .C .. ..........9? . BUILDING PERMIT ISSUED ............................................. DATE -. ADDITIONAL COMMENTS ............................................. . .. . ... . .-...... . ...........- I ------------ ...... .. ............... ... .................... ......._........._....- ... ........ ..._._..._............. _...._ . .... - FinalInspection by: .................f � .. ...........................:................_........................Date .Z../6-,�........................... EH 13 24 1-68 Rev. 5M � JOAQUIN LOCAL HEALTH DISTRICT 0/7h 3M