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FOR OFF CE USE: APPLICATION FOR SANITATION PERMIT Permit (Complete in Triplicate) Date Issued ..(.-...�_:. 7..L . . ____ This Permit Expires 1 Year From Date Issued Application is hereby made to the San oaquin 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 .._ Ta. ------ 1 � �J-�- CENSUS TRACT .......................... Owner's Name ....C. ._.. ... ---l-L` �t��......... ri Phone ._. . . Address ...4—fe 7— "Oev- .................... city L/C ter/ Contractor's Name . License # l�,r�.. Phone Installation will serve: Residence ❑Apartment House Commercial*lrailer Court ;❑ Motel ❑Other .. --_----------- -- Number of living units: .. ........ Number of bedrooms ............Garbage Grinder ............ Lot Size ..__ /f1- c s- ........ Water Supply: Public System and name ... ' --•----•- ----------------------------------------- -------------- Private)< Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom.13 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 on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( PACKAGE TREATMENT [ 1 SEPTIC TANK [ ] Size . ..la..-X- - ..l---Q ........ Liquid Depth ..... Capacity ._�.?dD...._ Type .................... Materiol..,� �c� No. Compartments .... ......_..or I Distance to nearest: Well .... !.�C?....... ..........Foundation -!Q ____.. . Prop. Line S............... LEACHING LINE [ ] No.)of Lines :... ..........Length of each line .. .5a... .......... Total Length ...._Xao........... D' Box r -- Type Filter Material`-X- �- - Deyth Filter'Material ...� ..../......-------- �,!►�. p i. T............. Distance to nearest: Well ..-/o.Q,�....--... Foundation ---eV.........�'..'Property Line �................ SEEPAGE PIT [ J Depth ..__.�----- Diameter Number ........ Rock Filled Yes No Q J Water Table Depth ..... - -----------------------------Rock Size .. .Z:x��?,.r_--.. Distance to nearest: Well .....•.................Foundation Prop, Line ... ................ i REPAIR/ADDITION(Prev. Sanitation Permit 5/# ................7.. ........ ..... Date ------------- --------------------1 �? f Septic Tank [Specify Requirements) ------- .... ............................. ...... - ----_--- .......................................... ... Disposal Field (Specify Requirements) ................................. ------ ------- ............. ------. . •--........----..............-- ......... ................. ................. ----------- -- --- ----- --------- ...... .......---...... --. ------ --------------•-- __ __ ..........--------....... ..... .......... ..':............ ................. I. (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 beco biect to Workman's C mpensation laws of California." Signed ...� A! ' ner) Owner _ 7itl�. ................. ................. . . .... . (ian ow DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. DATE ..... --_�_...***--------------- BUILDING PERMIT ISSUED ..... _ _ DATE .......................................... ADITIO L COMM T .. .. ......••..........................--................---...... ................. ....----..... ....--...... ...... .v_._ ...... .... . ........ . .....---.... ...... _................. ................. ................ ...... . FinalInspection by. . . .......------- ----------------.------------------. .•--......... ..Date r�.�...z .......... �JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 )-'68 R . 5M