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r o FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT &7 Permit No. ..7.__...... .. .........................•----. ............ [Complete in Triplicate) --- This Permit Expires 1 Year From Date Issued Date Issued 2cf?—/,3,D —IZApplication 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. 544 and existing Rules and Regulations. i ;fid 33'� :j—,001"q t-, {JOB ADDRESS/LOCATION -1 °.__. _. �""�"" -. . ....CENSUS TRACT ..............:..:...:.... *+�-� ��l//J Owner's Name _..sJ. ........... ....... 1.. �_ Ca......._............_._.....,..----...... ......................Phone � 1 Address .° f� ........ .�fr .._.... �.[. ................. City .0�e�'lc9!j. ........ -•-- ...... �1 � -•-`n -• Contractor's Name ....9P41dAl�':------•--..._ —P /:. ----------_-.License �X. .0 P�ionY/.. ./�J� Installation will serve: Residence X Apartment House❑ Commercial [:]Trailer Court 0 Motel []Other ........ ....... ----------------- O Number of living units:......, _... Number of bedrooms .......Garbage Grinder - ..-....... Lot Size ]'. . . -......... Water Supply: Public System and name ... -•-- -------------- -------------- ..........Pn ate. ii i ,__ Character,of.soil_to-a depth.of_3.feet: Sand n--- .Silt-S,Glay4o Peat E]—;-Sandy loam=Cloy--6oar ,- Hardpan ❑ Adobe ❑ Fill Material .._. ..... If yes, type ...-------L ................ (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 TRE=ATMENT [ ] SEPTIC TANK T j Size................................................ Liquid Depth .......................... Capacity P Y .. . --.--. ...--- Type -•-•................ Material............. ._....- No. Compartments IDistance to nearest: Well .:. _............................Foundation ....................._ Prop. Line --.---- ............. LEACHING LINE [ j No. of Lines .. .... . .. ..... Length of each line.... .................._.._. Total Length � 'D' Box Type Filter Material ____________________Depth Filter Material .... -....-..................____....... Distance to nearest: Well ........................ Foundation ..- Property line ........................ SEEPAGE PIT [ ) Depth Diameter ___________ ____ Number ........ ..............._... Rock Filled Yes ❑ No ❑ � Water Table Depth -------- -. ........... --- -----------Rock Size ....... ................... Distance to nearest: Well .... ..........................._._..Foundation --------- --..- Prop. Line _.__ ............... REPAIR/ADDITION(Prey. Sanitation Permit# _______________ _.._.-._.- Date ____._._..._____.____--____------) pecify Regyirements) i, . 1rr ... Disposal Field (Specify,Requirements!..../*Pq.......a :Sre/�_ .- ... o ...---.......:�,.....-•---'-" -.--------- --�"'- ------ ------ r._._..._,n.-....-. ............................................. =:-=.-T _ ........... ............. ........... ...............-----------.--..... ... - ---------.......----- .. ........----------------- .(Drdw existing and requiredaddition on reverse side) ' 1 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. e 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 bete su jec to orkm 's Compe atior ws f California." Signed .. ._ Owner By .... . . Title . ...� I.... ...... ....... .................... f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ........,��- P�s-..- - DATE ..... BUILDING PERMIT ISSUED .. .• . ... ..---- .--•---....--- • •---••------------------- -- -- -------- ----•- DATE . ..- ._.....- ........ ADDITIONAL COMMENTS ................... ........... ................ Final Inspection by: -•--• k_ ----•----------- --- --------------- ------------ Date ... -- SAN JOAQUIN LOCAL HEALTH DISTRICT � m 13 24 E. H. 1.'68 Rev. 5M __ 7/723 .K -