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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....... ......... Permit No. .._7,. =02(C (Complete in Triplicate) ......................•• ........I——............... D .................. This Permit Expires 1 Year From Date Issued ate issued ..7 f- .7. ..................... D 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/LOCATION ...CENSUS TRACE` ...... .................. � Owner's Nome n on Address ......... -•---•-- ........... City 660�V .......:...... .................... Contractor's Name A€ . .. Phone. ,PP�� (� . Installation will server `" Residence Apartment House❑ Commercial ❑Trailer Court 0 Motel 0 Other ............................................ Number of living units:....e_.4_ Number of bedrooms ...1,t�___.Garbage Grinder:,Y .. Lot Size �.j'e�-. K.. ............. -m / Water Supply: Public System and name -- ° ,/✓'-�AI, 1f19. 14,401...............................•..............__..__._Private ❑ Character of soil to a depth of 3 feet: Sand .. Silt❑ Gay ❑ ..Peat❑ F Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe Fill Material _----.-.-..- If yes,type ............................ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must W4 placed on reverse side.) NEW INSTALLATION: l (No.septic tank or seepage pit permitted,•_ f,public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] S.ixe................................................ Liquid Depth ..........................W ' a Capacity ---_ TYPe -•.................. Material----------_---...... No. Compartments ................. W 'Distance to nearest: Well .....................:..............Foundation ................... Prop. Line ...................... LEACHING LINE [ ] No.1of Lines ........................ Length of each line............................: Total Length D' Box . Type Filter Material ..Depth Filter Material Distance'fo nedrest: Well �Founciffion"..'__::..:..•-:- :--._." Property Line ........ .... ._._. :..........:..... SEEPAGE PIT rl[ ) Depth ------ Diameter .................. Number -------- _.---------... Rock Filled Yes ❑ No • Water Table Depth '*'!-.Rock Size ................................ ---- Distance to nearest: Well .....Foundation Prop. Line REPAIR/ADDITION-(Prev:San itatian-Permit-# .................. Dote............................... ' Septic Tank (Specify Requirements) ..... < � i �' Disposal Fiel (Specify Requirements) ' •-= �i/ ----- .. �!/___.�� --------- 411 _.................................................... ---------------- -----.......... .......... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the worOwill be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local.Health District. }tome owner or licen- sed agents signature certifies the following: 6.1 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 Compensgti.on`iaws of California." rt Signed _....... - - --------- .:_--------_-----. Owner . .� BY ._.......... . Title -•-- t= `� (If er than owner) FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY .. .,. .. -- z �.. . � .......................... DATE ... :..1 .:.1 ..... BUILDING PERMIT ISSUED .......DATE ADDITIONALCOMMENTS :..::...::.:...........:............••--•••-•-•---....-•---------------••--•--......_........- - -------------------------------------- ------- - .... ................................................................................. :.............. .................... ------ ------------------... ................ --•---•---------- Final Inspection by: .....----•-•.............. ........... ..........Date SAN.JOAQUIN ;LOCAL.HEALTH `DISTRICT I=. H. 13 241-'68 Rev. 5M 7/79 3•H