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4f'FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ...... .............................. (Complete in Triplicate) Permit No. _._...--,1....j3. This Permit Expires 1 Year From Date 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 Rules and Regulations: JOB ADDRESS/LOCATi N ..1..7a+ ......... . ......�_ - .......... .CENSUS TRACT Owner's Name .. .... . ...... ................:... ... ...... ..Phone ...._ ......................... Address ................ - .. ............................•---•- .......... City . .- --------------- ........... ............ ................... aga Contractor's Name .._._ _� .4z .. License # . '� . Phone .................. Installation will serve: Residence ❑Apartment Hoourrse0 Commercial []Trailer Court Motel ❑Other ......J4 .......... ........ Number of living units_____________ Number of bedrooms ............Garbage Grinder ............ Lot Size ......,S..11%7 1�........... Water Supply: Public System and name ..... .............................................................................................. .........Private Character of soil to a depth of 3 feet: Sand❑ ilt❑ Clay E] Peat❑ Sandy Loam ❑ Clay Loam 0 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 ublic sewer is available within 200 feet,) f'f i 1 �/ 04 PACKAGE TREATMENT [ ] SEPTIC TANK 1� Size.. e .1 �1....-- ._.` ___ Liquid Depth ....I/................... Capacity .04?Q.._ !4k Type ~ _.�.._. Mate/rial___ftn ®... No. Compartments i � i Distance to nea st: Well ...........12"...__._•---_.....Foundation ._.--gip__•.---.---- Prop. Line .... ..............J LEACHING LINE [�No. of Lines ...../---------------- Length of each lirie..._.'!��_•-----.-•____-- Total Length ..f��U...................,.,,j 'D' Box _... ..- Type Filter Material .,._.?�.�..___Depth Filter Material ......e.Y.... ............... � Distance to nearest: Well ....../0.4 ........ Foundation ---A060-- ..._____. Property Line f.:........... ' 3'� SEEPAGE PIT [ Depth ..-.P.Z.......S...... Diameter ....._..._.: .Number ..........I............... Rack Filled Yes GG�O .....Rock Size __� _.��X3...._. Water Table Depth .............:f.%P................... � - - ------ Distance to nearest: Well .........I.� ....................Foundation ._?..._..._... Prop. Line ..4 ............ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date ..................................) F SepticTank (Specify Requirements) ......---•...................•-•-----.......•----....-----•----......-----..........._.............----•-•-•._......_.....-•--------------;5.,., DisposalField (Specify Requirements) ..__....-• . -•............................................................•-----•--••----.......---•----_-----------------_- ..----•--------------------•------•------•------....--------------._......__._......_.......__......_.....----• ......................I..................... -•-----. -----•---- ....................1. ....----•-------------------------------------__......_.._....---............---.._.•..........----------•-.-•------._..............................--••-•--••---.._.__._...----------------------------.ifn (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 San Joaquin Local Health District. Horne owner or licen- 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 become subject to Workman's Compensation laws of California." Signed .............................................. ..t........_.._... Owner e4 BY ._... J itis �� . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..................... -------.-_...................... .................................. DATE .... .......... BUILDING PERMIT ISSUED .-• -• •- DATE ........................................... ADDITIONAL COMMENTS 3� . .. .... ...........I........ ............_.....I...__...I....--- • ........ .............:........•........---------- .. .. .. ................ ........•-----._.-..-...---..__...--------------........... ......................................-............ . .. .-- ------•- ........_. Final Inspection b Date T . Q ...,7 p Y.. -- ••------- ••----•-•......................................................••---........... .... SAN JOAQUIN LOCAL HEALTH DISTRICT F E. H.13 24 1-'68 Rev. 5M `��'!T3 ,K