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"xOR OFFICE USE: 3 APPLICATION FOR SANITATION PERMIT ...................................... ... / ;Complete inTr#plicate} Permit Na. -7..?........-36....... ......• This Permit Expires 1 Year From Date Issued Date Issued :7 Application is hereby made to the San Joaquin local Health District far a permit to construct and install the work herein described. This application is made`in compliance with County Ord#Hance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..c*-1qg......L. q�> a CENSUS TRACT Owner's Name r .....� ................. CrP,:. ....................................................... .........SL.. .....:........ Address ..�r1 f........................... City ..................... ................. ....... , Contractor's Name ........License # Phone i Installation will serve: Residence A artment House Commercial ❑Trailer Court Motel ❑Other ................. = Number of living units:...)--- ... Numlber of bedrooms .a.....Garbage Grinder. ------- Lot Size •-•90 ...` .'... ...................... Water Supply: Public System and no, - s.... ....................... Private, i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material .........---If yes,.type._................. ..... .. „� (Plot plan, showing size of lot, location of system In relation ta 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,} F PACKAGE TREATMENT [ ] SEPTIC TANK ] Size........... ..... Liquid Depth ....................... i i Capacity . ......... . ..... TypqNL . Moterial._O A;Tja.. No. Compartments i , _.4` r.............. 9 P � Distance to nearest: Well _._ ..a....._ ...........Foundation ..10.............. Prop. Line ------- --• N ASO-----------� LEACHING LINE [ ] No. of Lines .. r . ............... Length of each line...... __...__........ Total Length d�-`'10 'D' Box ... i..- Type Filter Material _ t1f " .''? Depth Filter Material ......1.9-11f Distance to nearest: Well1 OO „ +- .3©.................. --- •••- Foundation � Property Line �` SEEPAGE PIT [ ) Depth ........:........... Diameter .... Number ..................... .. Rock Filled Yes © No ❑ r Water Table-Depth Rock Size Distance to nearest: Well _......Foundation .. Prop. Line ' REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date SepticTank (Specify Requirements) .......................--....................._ ......-•-...........................................................•.................... I Disposal Field (Specify Requirements) ................................................. ......................................................................•----------.....-...----- .................................................-.............-........................ r .................................................. 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 Ruler, 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 t Wor n`s Co nsation laws of California." Signed ............. �J . Owner BY ................................. ..:... -- . �Itle ...-------------------------- ........................----•.......... (If other than owner} '-" ---. ...... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... DATE [ s ---------------•-•-•-----.............-----..............-.............. ....... ... .......... BUILDING PERMIT ISSUED .............. .... .. ....................•--..._ ----...- ....DATE ADDITIONAL COMMENTS ... °°......................................................... ....------. ...............I........................... ..................................... ............. ................... . . ..- ..................................... Final Inspection by; .• .......... ---- ------ - -----•---•--••-•---•----••-•---------:........_....__,................._.._.............................Date SAN JOAQUIN LOCAL HEALTH DISTRICT , E. H.13 24 1-'68 Rev. 5M