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FOR OFFICE USE: !! rrPLICATION FOR SANITATION PERMT _ ,! 30 .. .............. Permit No. 7� �T 4 (Complete in Triplicate) ............. ...... I :....... ..... ....................................... ... . .Issued Dare Issued ./...... . ... Is Permit Expires 1E Year From Date[ss .. .... 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 1ADDRESS/LOCATION ...... � ...... ...... .. . ......... . ..................................CENSUS TRACT .......................... i Owners Name ...............:a- -oKe—..... ,.. Sr Phone� '4��._ s .. Addressi _.. •............. ... City ... .. ... Contractor's Name .................... .....•-------....w. ........ ......... ..............License #;�sY,3.Y_--•-. Phone ... y Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court 0 E! Motel ❑Other ............. ••. ...................... r � 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 E] Clay [:] Peat❑ Sandy loam 0 Clay Loam C]- ; Hardpan ❑ Adobe Fill Material ............ If yes,type •--------------------------- jPlot 'plan, showing size of lot, location of system in relation for wells, buildings, etc. must be placed on reverse side.) v NEWINSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) W PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size---------------------------------- --- - -- -- Liquid Depth .................... ii Capacity -------------- Type Material.............. No. Compartments Distance to nearest: Well�l .Foundation ..................•--•----•._...,_. --•----....... ....... Prop. Line ...................... , LEACHING LINE ( I No. of Lines ........................ length of each line........................-... Total Length .................. 'D' Box ------------ Type Filter Material .................. yp ..Depth Filter Material ............................................ �J Distance to nearest: Well ..... Foundation ........................ Property Line ............. SEEA ,GE PIT [`j Depth .................... Diameter ............... Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ..............Rock Size Distance to nearest: Well .Foundation 1 Prop. line ._.................. REPAIR/ADDITION(Prev. Sanitation Permit# Date SepticTank (Specify Requirements) .................................................................•--• .............................................•--.._......----------- Disposal Field (Specify Requirements) ........... �. ~' - +*l...c"" •-••------•........ .......... ................ .................... ----- ---------..----•-.........------...--•--•-----.._---•----------------•---- ........................ .....-----------...........----- ........ �. (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 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 Compensatlan laws of California."" �� Signed •--------------•------•-------- . Owner BY • .•E. - ...... Title (If h e than owner) i Ei FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY ..................................................................................................... DATE.•----�,.�. `.��.---............ SSUED ... BUILDING PERMIT I ... ----------. ...--•-•----•--------.....................DATE ............................._............: ADDITIONALCOMMENTS • ............................................................................. .........1-.-------.............. ; - -------- .......................................................................................................................................... ........................................ ............ ........................... .......•.................. . ......7...... ........... ........................... Final Inspection by: ............................... :....... Date ............................................ i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M - 4