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SE:.. FOR OFFICE USE- .............I............. ...........:............. ............ APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .. ��t�� ... ........I This Permit Expires 1 Year From Date Issued Date Issued . .,a 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 ..... CENSUS..................... ..CENSUS TRACT Owner's Name ,f/��/.. .f.�1�11�� . !?! .................................---. . .............. .--...............__.Phone Address .. . . .....rel . :....��' ........................................... City .a , 11 ......................... .. Contractor's Name 1 � �f.-' i�� 1. License #pl�I .c✓��.. Phone .:.� �?..... Installation will serve: Residence Pf Apartment House❑ Commercial QTrailer Court 0 Motel ❑Other -----••-------------=------------------- -- Number of living units:_....... Number of bedrooms _....Garbage Grinder-'/ ... Lot Size lge.,X/y.z.................... Water Supply: Public System and name .._ ....4167e��. ......-.......................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat❑ Sondy Loam ❑ Cloy Loam ❑ Hardpan ❑ Adobo X Fill Material ............:If yes,type ............................ Plot plan, shown ( p showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.] j NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC ��•�_ T e .f. - Si`��9 a�.� ./1�.�._.-_--Na. LiuiifDepth -�'`�• ............... .. Capacityl . yP ,, Compartments ............ Distance to nearesh Well .... Prop. Line ?-O✓ --=--------................Foundation ...lf..-•---•.. ...................... LEACHING LINE No, of Lines ...d2:............... Length of each line.._ez$ .................. Total length ./70................ pp D' B-xll�.,��.... Type Filter MaterialAywo e;Depth Filter Material _Ap..°..._.__..._...................... ✓ .. Distance to nearest: Well r'........--- Foundation .......... Property line ............. SEEPAGE PIT KJ Depth A07 ....... Diameter ....... Number........5--..._...........Rock-Filled Yes ;' • No,(:] Water Table Depth ...&s f r Rock Size l�_�-:-_ ,Foundctlon .Ae Distanre_townearest:MWellw.......:r--.�" . - _.. Prop. Line 3.f................. REPAIR/ADDITION(Prev. Sanitation Permit# ._.._....;:.........................••----__ Date .................................. --.....----•-•................... SepticTank (Specify Requirements) ----------------------------------------------------•-- .................................. ........ ..................... •------------ Disposal Field (Specify Requirements) _______________._ ............................I...... ............................................. ..........................................................• •._..--------•--..-,-...-----............................... ..............................:.....:....................... ^~-"(Draw existing'and-required addition on reverse side) � I hereby certify that I have prepared this applic4a. tion 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 w lt,"his permit is Issued, { shall not employ any person in such manner as to become subject to Workman's Compensation Haws of California." y Signed ............... ..... ................. Owner Y . Title ther than owner) FOR DEPARTMENT USE ONLY ... DATE ......�......... APPLICATION ACCEPTED BY .. ....... BUILDING PERMIT ISSUED ..DATE ..................... ADDITIONALCOMMENTS ....................._....---......-•---..........-•--•-•--._......................_.:...._...---•-•.............. - Final-Ins action b'... ....-... -••-•---...... - -'.............................................................. ._.._......._ _-��__,�.J� -•• Inspection y; .........................................................Date ..........r..................... -......... SAN JOAQUIN LOCAL HEALTH DISTRICT �� E. H.13 241.'68 Rev- 5M 7/72 3-M