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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete-in Triplicate) Permit No. ;?57�7. 0, This Permit Expires f Year from Date Issued Date Issued . -1 -.2 S. 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. 5:49 and existing Rules and Regulations: JOB ADDRESS/LOCATIO �/��. ---.....�._..��"�.._ .............................CENSUS TRACT _............... ......... Owner's Name ......... ... ............. __. -- ................................_,.......... Phone Address. .. °. .......... ._...,City .. .. Contractor's Name.... .----------:•-•--.- .__....:....... License # 1�� y Phone .........__ Installation will server Residence Apartment Housefl Commercial oTrailer Court 0 Motel0 Other ............................................ Number of living units--------/-__ Number of bedrooms ....3....Garbage Grinder ..._._...- Lot Size .. - .............. Water Supply: Public System and name ............................................................ Private [1�/� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam O Clay.Loam Q� Hardpan [) Adobe Fill Material ,........... if yes,typo..............I ............ (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 [ ' SEPTIC TANK f ] Size......................... Liquid Depth .........................r ' Capacity _------ Material...................... No. Compartments Distance to nearest: Well -------........•....................Foundation ...................... Prop. Line ......................N LEACHING LINE [ ] Na. of Lines ________________________ Length of each line..............................Total Length ..............z D' Box --__-.__... Type .Filter Material ....................Depth Filter Material Distance to nearest: Well ------------------------ Foundation .................. Property Line ........................3 SEEPAGE PIT [ ] Depth -------------------- Diameter ................ Number -----...........I........... Rock Filled Yes ❑ No (:3 0 f Water Table Depth 0 ----------------------------------•-•-----•-----Rock Size ................................ Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ......................` REPAIR/ADDITION(Prev. Sanitation Permit# ---.----•------------------------- ......... Date ...........--.------------........ ) Septic Tank (Specify Requirements). -------------------------------•-- j Disposal Fi Id (Specify Requirements) .... 0 ------"�ft.._`��r - -r.. ..--- -------:..._. .1 v _---- - - .. .. -----------------------------•--------------------- ------------------- - ---------......................I......................... ........... .................................... (Deaw 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ---•--------_----•---- Owner title _.. - Ilf other than owner} /FOR DEPARTMENT DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY _-- -- --_..--•--- -- DATE .',,. _' _.S -,. „ BUILDING PERMIT ISSUED .......------------ ------- - --- - -------------••----•----•--•-••--•---------------------...-----...------------DATE -.-. --...----------•----- ...... ADDITIONAL COMMENTS --------------•.--.----•---..___......_ ._ ._ ._.__ - _ ---------------------•------------.-_- .....------------•------------------------._..._....... - ------------------------------•• ....__ - - S� Final Inspection by- - �:....._._ . •--...Date . Eft 13 24 1-68 Hev. 5M SAN :10AQUIN LOCAL HEALTH DISTRICT $/7h 3M