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FOR OFFICE LI rAPPLICATION FOR SANITATION PERMIT _..._........�!.:�1.�...... --•-•---'•.............. Permit No. ..7. .... ........ !Complete in Triplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the Son 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION __.... ----. f.•. -- ---- .._._._...CENSUS TRACT .......................... r � N _ , Phone ., s •&.74r. Owner's Nome ....._ Address ..------ �....... .. City :.. _:....... ... .. .. _.License #CZk_/� phane , a� Contractor's Name Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ I Motel ��❑Other ...._------- ----------- ------------_- Number of living units:. .. Number of bedrooms ..._Garbage Grinder lot Size ..�j .� - �• f } [ Water Supply: Public System and name .... _ Private ❑ b•Character of soil to a depth of 3 feet: Sand Silt[] Clay ❑ Peat[:1 Sandy Loam ❑ Clay Loam ❑ � t - 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 seep�a•-gee p)t permitted ! public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK ---- -------------------•.•- ............ liquid Depth __.._..........---........ Capacity . Type -----------•--- Material---------- No. Compartments ----------•-•----° V( 4' Distance to nearest: Well . .................................Foundation ...._.._. ------- Prop. Line ..._._._..-- .-.-•-. LEACHING LINE lky" No. of Lines Length of each line ..._.-_ ... Total Length .- - .---- • 'D' BoFc----Type Filter Material ALa-••Depth Filter Material ......... ......................:.......__- Distance to nearest: Well -:- 1. aundation -. .-.T--.- Property Line SEEPAGE PIT Depth Diameter J- Number .... Rock Filled Yes No 9 Water Table Depth �� --------- -------•--_-•-Rock Size . ..... .----.._.. r Distance to nearest: Well ....FoundationX111- Prop. Line __ ^..._.--.•. REPAIR/ADDITION(Prev. Sanitation Permit# --------.--•--- ------ Date -------- ................ Septic Tank (Specify Requirements) ..................... ............ -..--------------- - r Disposal Field (Specify Requirements) --- ... --F.-... ...�-G *'�- - --......-.._........ .................• -•--...__.. (Draw existing and required a ditio n reverse side) I hereby certify that i have prepared this application and that the work will be dome in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or [icon- sod agents signature certifies the following- "I ollowing:"i certify that in the performance of the work for which this permit is issued, 1 shall not employ any parson in such manner 1 as to become subject to Workman's Compensation laws of California." l Signed .:................ .... -------- -------- ------- Owner Ti By eTther than owner) ' FOR DEPART NT USE ONLY _ _ I APPLICATION ACCEPTED BY _. ... GG�C/ . ........ .. ... ...... DATE .__..... .. - ........ ._ BUILDING PERMIT ISSUED ................ - -------._ . ... --• .......DATE ._-----....._......_...._.._........... ..... ADDITIONAL COMMENTS ..�_F - - D. - ------------------------- ------ .. . . . ...................................... ----... ---- . -------- -- .-- ----------- .. __.- --....._..-....__..................._....----------.._ _..__.._..-- . ------------------------------ ............ ............... t - (-I- . Final Inspection by. ........... SAN JOAQUIN LOCAL. HEALTH DISTRICT / 7/72 3 M c u 13 241 -to o_.. rAIA �'�