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APPLICATION FOR SANITATION PERMIT This Permit Expires 1 Year from Date Issued Momplete in Triplicate) Date Issued e?- / Permit No, 7l - `I 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 Count Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .721 c' 1- CENSUS TRACT . FOR OFFICE USE: (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 seep e pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK f sizet/ #.1' 9 Liquid Depth 54 No. of Lines Length of each line i4VO DAT-45-2— ,DATE Owner's Name Phone Address ageae-owoe.o.,.*.%.47 City Contractor's Name. .... ,License #4/1-AZFL, Phone I nstallation will serve: Resi e •e 0 Apartment Housefj Comm rcial .0Trailer Court ,472, Motel D Other . ............. 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 0 slit 0 Clay 7 Peat 0 Sandy Loom 0 Clay Loam E:), Hardpan Adobe 0 Fill Material ..... If yes, type \si Nsi avt......10,.) Capacity ig2.64. a. Type .. , .. Material. "—A,4144r..Na. Compartment LEACHING LINE to( Distance to nearest: Well ...... . .. Foundation 1 10 / Total Length i Q 4) 1 Prop. Line ..r - NI '13* Box . ...... .... Type Filter Material ....5 2,.. . Depth Filter Material /f il Distance to nearest: Well 5b ' Foundation PP i Property Line 4.r " SEEPAGE PIT Depth gp r ' . , Diameter 3.3..1' Numbe- . ...... .X7.... , Rock Filled Yes , No C. / if. .., Water Table Depth ?o1 Rock Size ii.A.X .4 Distance to nearest: Well ,__......1.P.P._./. ....... ______Foundation ...../. 0..,/. . . . .._ Prop. Line ...S.............. REPAIR/ADDITION (Prey. Sanitation Permit # es. ) Date , Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) (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. Horne 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." ... Owner Signed By ...... Title .. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED ADDITIONAL COMMENTS ........ • y • Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT Date 9 - 4P'-77 F. H. 9 1-'68 Rev. 5M