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t FOR OFFICE USE: ` -'� APPLICATION FOR SANITATION PERMIT ..........-.<`:...................... ... . (Complete in Triplicate) Permit No. . This Permit Expires 1 Year From bate issued Date issued ................... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work described, This application is made In compliance with County Ordinance No. S49 and existirtig Rules and Regulations: � �n Y. or JOB. ADDRESS/LOCATION J , ............. GENS Owner's Name �n� "` RACT I Address ..`:.-:_::_ ....... _� :. _ _�. w j Ph ne � . ... : City �Contractor's ----•••• - ._ tion will serve: RLicense # Phon e J /re I7 ,f esidence ..................... artHouse 0 Commercial ❑Traller Court Motel ❑Other Number .of,living units:.....( m ...... Number, of_be'droos -.�----.Garbage Grinder ?J._ _ lot Size, .... - Water Supply:.Public System and name,------•-----•-----• _ - --••- •-------------•-- -• Character of.soil to a depth of 3 feet: Sand�] Silt Clay ................ ............................................Private ®/ . ❑ ._ y ❑ ' Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobeill Material --,-,4A-' -_- ---. #f yes,type _•• (Plot plan,.showing size of lot, location of system in relation to.wells, buildings, etc, must be placed ..on reverse NEW INSTALLATION: side.] (No septic tank or seepage ,pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ... [ ] SEPTIC TANK� ) � . - . •"�' _. '• Capaci#y -----•- -----.._. i ...---•• ................--•--.... . ... .......TYPe'-----....- Material.__. Liquid eat ..-- Distance to nearest. Well N Compartments - Foundation'. LEACHING LINE ....I..._...I—---- --- •. .._ - Prop. Line No. of • Length of each line..._..---•----- Lines � ,. Total Length ---..•...-------•. :.-'--- , D Box ---•----- Type Filter Material ...Depth Filter Material f .......... „ Distance to nearest: Well' �-�--- -- Foundation Property n -.-SEEPAGE PIT• { 1 Depth Diameter r e .. _ . Water Table.,Depth ...................................... . .. Rock Filled Yes C] 00 :...... .:.......Rock Size _.. •. Distance to-nearest: Well ........ .Foundation ........... REPAIR/ADDITION(Prev. Sanitation Permit�# ...-:- .-__-- - - i ................... '” . ......._ -- •--------------------- Date Prop. Line ....... ... . Septic Tank (Specify Requirements) ............."._._....:_.. _ " Disposal d (Spec;fy Requirements) jJ� 77 ------- k...................................lJ .� .........__.. >f .......... ••--- --- - (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 Son Joaquin local Health District: sed agents signature certifies the following: Honie"owner or licen- "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 became subject to Workman's Compensation laws of California.". Signed ..........__ _......_ --------------------------------------------- other _........ Title __. { than owner) r-7................... FOR DEPARTUFf4y, USE ONLY APPLICATION ACCEPTED By. BUILDING PERMIT ISSUED .,............. -•---- ............................ QATE � ............:...................DATE ................. ADDITIONAL COMMENTS -----------=-=--- r rY Final InspectEon by: -.. r.................................... ' ............. -_... ...................... -- Date :..._ ..... ... _SAN JOAQIJINr.LOCAL HEALTH DISTRICT E. H, L3 241.'68 Rev. SM