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FOR OFFICE USE: / APPLICATION FOR SANITATION PERMIT , �S 7 t Permit No. ... 7..=_........ ............................................ (Complete In'Triplicate) ............... ' � Rate issued .............��.'... This Permit Expires 1 Y ar From 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 it ourity Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION �1 ----- ............... CENSUS TRACT .. :` . f1Z -I Phone ......... Owner's Name . ..� ---------------------------- _..... _ . .. �. �..--!!.k'[ . � _. ------------------• 'city _ ............................................' .. Address .............. �. : ---.. . .. .. ....-- -•-----•--- ........... • f / .� . .... ,.r L�1rL7.... ..._ ... _ ��/,1'--------------••--• .License #��'�'3.}:�. Phone - �,�-� Contractor''s Name _ � .....- --� ...��.:. ---- •--�� - �. Installdtion will"serve: `Residence=(Apartment House 0 Commercial ❑Trailer Court ❑ \ hMote --•--- Lot Size ..__4A. ... 1 .............. Number of living units:....... ...__ Numb-er:of,bedrooms ---:Garbage Grinder .__ I. j. f, Z V Private Water Supply: Public System and name ............... .-..._..... .1h''' r e ❑ P ' t Character of soil toa de depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ P .. . f 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.j �NEW;INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT ( ] SEPTIC TANK{] Size......... -...--- Li quid Depth ........... ............. . ......... t .. No. Compartments Capacity �,,��TYpe ••----------------. Material-----•-••---.. Distance to nearrst: Well� Foundation .......I.............. Prop. Line ._...........__.__.... { .... Total Len th t � 4 ! g LEACHING,LINE� ( ] No. of Lines ..�__....__�_._..._� length of each line........................ •-•---•----....---...-•----• •-4- '.D'. Box :—.-�:�sype Filter Material ....................Depth Filter Material ...._....--------...-- • - � Distance to nearest: Well .........t............... Foundation ... .................... Property Line ...----.•...........,__-- —SEEPAGE PIT [ ) Depth ..................... Diameter ................ Number ._._..---------- ........... Rock Filled Yes ❑ No Q Water-Table-Depth-= ...,.. :— ......:........Rock Size ::_: Distance to nearest Well IFovndation .................... Prop. line .---..._...._:...__... -----•-"-----------••................... REPAIR/ADDITION-{Preva Sanitation Permit�# ..:............ Date __............._....._._....__....) .............•••• .. 1 SepticTank (�pecify Requirements) ....................... .._.....................................................--------.-....--••-----------------.-.._........-----.. Disposal Field (Specify Requirement ) ---- . -----.•... ... -••• .... F ______________ __..... !Si_ ________________________ ________________________ ______________________________________ _i.....___.......__....____...._._......___.....__ __...._.....--......_....._.. . _.. •...! � i {Dra�ir existing and required addition on reverse side) I her eby certify that I have prelidred;this application and that, the work will be done in accordance with San Joaquin k County 6rdinances, State Laws, arid4Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature cerkifies the "I certify that in the performance of the work for which this .permit Is Iss ed, I shall not employ any person In such manner E as to become subject to#Workman's Compensation laws of California." . Signed V. Owner By .._..... �_ +. .. .............•--------_. ................ Title ._.._ '_............ .......................................... . {If oth Fttian�o er}' ._ t FOR DEPARTMENT L15E ONLY - e t APPLICATION ACCEPTED BY --------- .......... DATE •--• ...........;-----•r... ,-•-•- I BUILDING PERMIT .l5SUED TE . D .......................................... ADDITIONAL COMMENTS __ t ....................... ...::.................... .................. . r -•....•• • ( ti - •.•.-.•...••.•-•........................ --....... .__..._.........-__ . -. . . .• Y :.... l� = ..-Date . ....._ ..---- Final Inspection by: . C` SAN4UIN L HEALTH DISTRICT �7'/ g- 7/72 3 YDS