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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' Permit No. .:._... 1 ...................... ...._. ----------- (Complete in Triplicate) : Date issuedThis Permit Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made lin compliance with County Ordinance No. 349 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._/.. 1. !`.._.. v�/ .f!`- e✓I .....................................CENSUS TRACT. .lrW_ Owner's Name •C. t�5. .i% ....c._ep..gp_S.._1..._....._.. ...... ....:......... ....... o `^ .. v Address .. ��..,.y-:... ...y _r.{d. ..:. Cit l..C._:_ ..... 4 t Contractor s Name ........ . ------------__- License # Phone .............................. installation will serve: Residence DTA"partment House Commercial ❑Trailer Court -0 i r Motel ❑Other ................ -•----- -- Number of living units.,...-/..... Number of bedrooms _..497n7--Garbage Grinder Lot Size _l ir-.�f•-a Water Supply: Public System and name ----------------- ------------------------------------ ----....--------•- ------------•----•-------------------Private . Character of soil to a depth of 3 feet:..._ Sand Silt Peat-_—Son d. ,Loam-- M _Cla Loam Hardpan ❑ Adobe (Fill Materia! ............ If yes,type ........... .............. (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) p seepage pit permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or � PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size--- -------------- r� _ ................ Liquid Depth .......................... -- Capacity .laeoc?.._ Type .................... Materia!_._ ... .. ------ No. Compartments ..-�_._........:..._ Distance to nearest: .Well ..,.�r'1..`-�.Apx�._Foundation .... Prop. Line ®_�......_ LEACHING LINE [ ] No. of Lines �. Length of each line ....... 6�7 Total Length 'D' Box .... ._ . Type Filter Mate%alSP�Foundation 20.C-.Depth dat on �D MaterialProperty Line -.a2Q-.�..------ 0 Distance to nearest: Well -. ��..__ .. SEEPAGE PIT ] Depth Diameter ................ Number .......,. . Rock Filled Yes ❑ Na (] 00 Water Table Depth ---------------Rock Size --------..... ------------ 00 Distance to nearest: Well --------------------------------------..Foundation --------- ---- Prop. Line ....-------...-- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- •--- ............. Date ------_--------------- ----------1 i I Septic Tank (Specify Requirements) ................ .......... ............ Disposal Field (Specify Requirements) ---------------------------------------- - G .... - . .a.....,.,_ _ _ ._.... _ {Draw existing and required addition on reverse side} k I hereby certify that 1 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 becom subject to Workman's Compensation laws of California." �- Signed ' .. - ----------------- Owner _ Title . .. . ... ...............A--__-- (If other than owner) FOR DEPARTMENT USE ONLY ILDLICA710N ACCEPTED BY .�.t_.�. DATE ..�. a$ .-.._...--•---• ------- ........... .._... BUILDING PERMIT ISSUED ._..�. ...f _._. - _ .. --- E . ....--...._........-----•................ ADDITIONAL COMMENTS--�... . ..-- - - ------ - ------- `� ................. Final Inspectio b . .....-- .. . - - ---- -- - _ Date .. . . y :.. ..._........ SAN JOAQUIN LOCAL HEALTH DISTRICT 7 a %L, C.. _... _ .7/72 3 M