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fJX OFFICE USE: APPLICATION FOR SANITATION PERMIT .,a., - (Complete in Triplicate) Permit . ..................... .................................... •---- mit e o ry G' ..........R................................. This Permit Expires 1 Year From ba#s Issued Date Issued ........... . Application 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. 549 and existing mules and Regulations: JOB ADDRESS/LOCATION ......`-........__ . .__...- I ..... ...............................CENSUS TRACT ....................... Owner's Name - - . Phone /. CAddress _�-49. 0 C -�!..... .. Yoe. ..�.A9 ........... Contractor's Name - s.S�J-. City .......................License ,1 Phone Installation will serve: ! Residence Apartment House❑ Commercial ❑Trailer Court ❑ :j. Motel ❑Other Number of living units.---:: ------- Number of bedrooms ..........:_Garbage Grinder ........ Lot Size ...... Water Supply: Public System and name ............. Private ❑ . ................................................... Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy.Loam ❑ Clay Loam ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC{ ) Size................................................ Liquid Depth ............. capacity p tY Type .-....... Material . No. Compartments Distance to nearest: Well --.--...-- ---_ -Foundation ...................... Prop. Line .......................0 LEACHING LINE [ J No. of Lines ------------------------ Length of each line.-..---..................... Total Length V. Sax ............ Type Filter Material _,..._..----_-----Depth Filter Material ............................................ Distance to nearest: Well -------_•--------------- Foundation ........................ Property Line L i SEEPAGE PIT [ 3 Depth .................... Diameter ---------------. Number .-------_--.-.--------.--- Rock Filled Yes ❑ No 0 • Water Table Depth ------...................._-•-------- ---.....Rock Size ................................ Distance to nearest: Well --.-•---•.................. ............Foundation ----_------------. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...... ............. ..................... ate .......................... .. . [ V' Tank T Septic an (Specify Requirements( .-.:_-. -�-- G --..$-- .......... .c�. �.. ._ Disposal Field (Specify Requirements) .. _ ------------------------ ---- --- --------- ---- prepare(Drow existing and required addition-on reverse side) A 1 hereby certify that l haus d 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;Dislrfet. Home owner or licen- sed agents signature certifies the following: 1:certify that In the performance of the work for which this permit is issued,71 shall not employ any person in such mai nner as to become subject to Workman's Compensation laws of California." Signed --- --- ----- ---- ...... Owner By /1 --------------------------•-•-------- Title --sr: / (i other th owner) FOR DEPARTMENT USIr ONLY APPLICATION ACCEPTED I BY ------------ -----•_ -• c�- -• ----•-------------•-------------:---------:-----.�.:------•-•�:----. DATE,,,....--,:.... j'.7)----..,_,.-..-._� r BUILDING' PERMIT ISSUE© - ...:..--..... ......... .... ---------------- ------------DATE .......................-...-.............. ADDITIC)IAL C9MMENTS .�rl l-- �i�!�r • y4� �[ I . 1 - �.�.s.2.F..-. �air.�:�.1 LP� PItP, °:4fC/P ./�"��z -�H- oGl CO± ..r -_ ....................................... ................ - — ..................•----••-.......................... ...... Final Inspection by: . -�.. ... =. ---------------------------•- --------------- ate �................_._. + EH 13 2b 1-58 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M