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FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT !.... . Permit No. ...-- 1 (Complete in Triplicate) - ............. k•- Dote Issued ._....�_...:...... ................ . This Permit Expires ires ] Year From Date Issued Application is } ereby made to the San Joaquin 'Local Health District'for."a'permit to construct and install the work herein :I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: s' . . ..... __...CENSUS TRACT JOB ADDRESS/LOCATION ......... ... hone ........ .._....._.......... Owner's Name / f : a p............ ......._. .......... ......._. Address ... �V.'... _.. City .� _ I` Contractor's Name .. G�,/ 1 � ...... ..................License #o7.fl .�..... Phone Installation will serve: Residence MApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .......:.................................... Number of living units:__j._._ Number of bedrooms .!Z.••__Garbage Grinder .e!Y40.. Lot Size .� . ......•••••...... Water Supply: Public System and name ....................................----------•-- -----------••-- -•----.-----.............-••----- .._....Private . Character of soil to a depth of 3 feet: Sand❑ . Silt❑ ' .Clay ❑ Peat❑ Sandy Loam C] Clay Loam ❑ Hardpan ❑ Adobh� Fill Material .........._ If yes.type -------------------------- -- (Piot plan, showing size of lot,.:location ofsystem 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 TANK{ ] Size...._.......—-------•------------•............. Liquid Depth .......................... 1 Capacity TypeMaterial...................... No. Compartments ...................— _r-. . , Distance to nearest: Well .................:...............:.Foundation .-----._. ...... Prop. Line ................. ..... LEACHING LINE { No. of Lines ---------------------- Length.of-each—line--_..__-----.--------------- Total Length ..----------••-_---.-.: D' Box Type Filter Material ................... Depth Filter Material ... _._'... Distance to nearest: Well ._ ..... Foundation ............. .......' Property Line. ...................... ... SEEPAGE PIT [ Depth ..... .. ........... Diameter ................ Number ............. .......... Rock Filled Yes E:] No Water Table Depth ................. ..:....:....: ...........Rock Size ................................ Distance to nearest: Well .1'YVV� &.. - _1�,.. .....Foundation .................... Prop. Line ...._..•___-------- - I . I. REPAIR/ADDITION(Prev.;Sonitation Permit# ............................................ Date -•-•-----•_--•--_.-.•----- -...---- t 1 Septic Tank (Specify Reguirements)..:........... -----•` - _. � -----. ....--....- .......I.-........... Disposal Field (Specify -Requirements) d_'F' •• _. ................................----................-- ......------------_........---------•--------------- ._.... l (Draw existing and required addition on reverse side) 1 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 Regulptions 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 work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ` Owner BY � - " .._-•.•. ................•...... Title .._....................................... er than owner) All FOR DEPARTMENT USE ONLY ' DATE ....F .�... ................. APPLICATION ACCEPTED BY ..... °..F• •- - . ..-- •-------------------------- --•-----•- ----......-••-•----- . BUILDING PERMIT ISSUED .....:........... ,. ` ' ...DATE ...-- ..........--••-- - ...... ADDITIONAL COMMENTS ............................................ •••....... ..... . - 7sFinal Inspection by: D e .. SAN JOAQUIN LOCAL' HEALTH DISTRICT . ... ..... - - a r u 13 24,-,Aa P. -RAA - 7/72 3 .K --