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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..��:•3-6� .................................................. {Complete in Triplicate) .............................. Date Issued ...�r^..7" 7T This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin..,Local Health District for d permit to construct and install the work herein described. This application is made in,,cotnplidnce�,with County/?rdinance N'6_549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ........_... .1 '. ........ ......................CENSUS TRACT ..................:....... ,, C7 .........Phone.. �.rQ..._�. ...... ..............:......... Owner's Name •"-"'� '� -------••---...... 47_.S ,.. -�......., . k . city ..- Address -"'-"- Contractor's Name ----- ---•--- - - ------- - ---------------------------------• License #C?�_��.� .. ._. Phone ..:.............. Installation will serve: Residence partment Hauser Commercial []Trailer Court ] MotelC]Other ...-----•-•--.. . .....--•... ......... .... r Lot Size .. . __ v �•-•--....: Number of living units:.......1.-.. Number of bedr ms ._��_.--�Ga//rb��a��e Grinder ��i� .�-� ' " Water Supply: Public System and Ka . Yid• -- ................Private Q Character of soil to a depth of 3 feet: . Sand 0 r$ilt❑� YClay Peat❑ _- Sandy Loam fl Clay Loam 0 � If es, a -_---_----•---------• - V Hardpan ❑ Adobe ill Material Y 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 seepage pit permitfed if public sewer is available within 200 feet,] PACKAGE TREATMENT [ -t J Size....................................:.: .. Liquid Depth .. SEPTIC TANK .. No. Compartments ...:._._.. Capacity .................... Type --------------- .. Material---•-•............. ......_..... =. . ..... Prop. Line __Foundation Distance to nearest: Well ••-`•-"" --' Length of each line ....._. Total Length ............................ . LEACHING LINE [ ] No. of Lines .--------•••---------- • ................••: I� 'D' Box ..------•-•- Type e Filter Material --•---•-•----••.....Depth Filter Material -----------------------•----•--- ---------•- 1 Distance to nearest: Well ........................ Foundation .........:.......I... • Property Line .......................... i SEEPAGE PIT [ ) Depth ................•_-• Diameter ......,__.... - -----_--. Rock Filled Yes No [] Water Table Depth --------- ............................Rock Size - Distance to nearest: Weil ---------------•--•.....................Foundation ......-_---------- Prop. Line ---- ------_--.--- REPAIR/ADDITION(Prev. Sanitation Permit# ...........-...........-.................... Date ...::............................. Ior - Septic Tank (Specify Requirements) .......... -------------- f Disposal Field (Spec' Requirements) ..--- -- ----- f �/ _. . ---.....--- -----•----------- -------------------- .............................---.... - ....__. ---- -------- - - --------- ------ - .._...--- _..... (Draw existing and required addition on reverse side) I hereby certify that I have prepared thisapplication 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 worn for which this permit is issued,"l shah not employ any person in such manses as to become subject to Workman's Compensation laws of California." Signed .. .--- ----- Owner i BY - ---- Title .... ..._ ........ . (I f. other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....____ _ DATE - ...7...----•-....... BUILDING PERMIT ISSUED ----....•--...DATE .................................. -••................ ..... ADDITIONAL COMMENTS _ ..............•-.............. :....... - :....................... .---------- -- ------•-• -. .._ ._. t ----•• ---........ Date .._._...... ! 7 Final Inspection by. .....__.. ....••- - SAN JOAQUIN LOCAL HEALTH DISTRICT .. f�W 7/72 3 M