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_.. ..,,_. 'APPLICATION FOR SANITATION PERIIMT, �- �/� :. ... ......................................... (Complete Its Triplicate) Permit No. ... ......... .. ....... . This Permit Expires ] Year From Data Issued t Date Issued . '.'? 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. 5449 and existing Rules and Regulationst JOB ADDRESSAOCATION .•........•......... tl- ki p? .. "- -...............CENSUS TRACT .........................._ Owner's Name .� z-.. �' . ............... ...............---...... . ...................................Phone;�-.41 ;� i Address. ................................' .. ��`.� �. ._ . __.. ....ccity --- - . . . .........-- ------...._.. ......... .. .. Contractor's Name .. - License :M.... • Installation will serve, Rasidence partment House❑ Commercial❑Trailer Court ❑ Mote! ❑Other ---------- •.................•----•-•-.--•-- Number of living units:............ Plumber of bedrooms ..}.....Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ...--------- -•--•-----•---._.._.....................----------•----..................................Private �- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Poot❑ Sandy Loom ❑ 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 an reverse slde.N NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is vailable within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK{ ) ........ Liquid Depth .........................� Capacity J 0L?�.Type ._- Material...... No. Compartments Distance to nearest. Well ....I ..�.....--------------..Foundation -�-�---..j......------•- . Prop. Line ---------------...... LEACHING LINE ( ) No. of Lines ............... Length of each line.... Total Length ..2-1-.5�!............. D' Box Type Filter Material ....Depth Filter Material _.......... 2a .................... Distance to neorest: Well ......... Foundation ........................ Property Line ........................ SEEPAGE PIT ( ( Depth .................... Diameter ................ Number ......_.... ................ Rock Filled Yes ❑ No WaterTable Depth ................................................Rock Size ..............................- .. Foundation ...... Prop. Line Distance to nearest: Well ._._..---•------•----•.............. _............. .........-------•--• REPAIR/ADDITION lPrev. Sanitation Permit# ............................................ Date ..__................... ...) Septic Tank (Specify Requirements ---•-•.............................--------.-.-.-....-..--------•-----._...---...--...... DisposalField (Specify Requirements) ....................................................................•..--------•.......-..---------.._.-----.....----•---•-•-------. ........----•---------•......................•----....----- ------------..........-----.... ........---.-.... (Draw existing and 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. Homo 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 Work an's CompQnsatton laws of California." Signed ..... t.... ............... . Owner By .................................................................... .................................. litie ........................................................................ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._..... .,.............. .•----...------...---...............................----.........:"- DATE ....... a ............... BUILDING PERMIT ISSUED .. � x ......-.- ATE ..... tiADDITIONAL COMMr .......... .s?..... `.................. ........................ ------------------ ------•--•------.................----.---•--._................... ------------........_..._._.-.._...--........................................... ..............I......................... . ................I.......................... Final Inspection by: .--Eli - ................ Date ... .. -. .�?. 7 rc?............ 13 21l 1'68 ttay.• 5�t SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 „311