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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT 7 s"- 5-0-1- 7-- _ .....:... Permit No. .. ---....'....-- (Complete in Triplicate) S Date Issued . .`_...._........ { �,. This Permit Expires 1 Year From Data Issued 1........... .+.'+Ptd.. .............. 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 Ordinan a No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCATION .... / ; L....... CENSl15 TRACT ....-Q .......-. -r- - -------------------------- r... .....Phone .................................... Owner's Name � -...................... Address ,.... .. _ ...................................•- --. City - -- ! . Contractor's Name._, .. License # QGfiJ� . Phone L....................._ Installation will serve: Residence IX Apartment House,)] Commercial []Trailer Court ❑ Motel ❑Other ------ --•- ------ a ' :2 �'. Lot Size-J D- 'ra��! .�C�............ Number of living units:.. . Number of bedrooms _....._.____Garb ge Grinder ..... pA_ t c1 . .._ ............. • ----Private ❑ � Water Supply: Public System and name ..... --- .----•-----....._. i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 k3 Hardpan ❑ Adobe j Fill Material -.. ..._.... If yet, •• (Plot plan, showing size of lot, allocation of system in relation to wells, buildings, etc.' must be placed on reverse side.) NEW INSTALLATION: (No seermit tic tank or seepage pit ted if public sewer is available within 200 feet,) ppermitted PACKAGE TREATMENT [ ] SEPTIC TANK j ] ,S�Frfe:..��--------------------- Liquid Depth .......................... `, 1 Capacity Type ............... .... Material.......-....:. ........ No. Compartments -------. ----.------- �1 Distance to nearest: Well . ----_--.........-----------------Foundation ........ ............. Prop. Line ---_-•- --- - LEACHING LINE [ �No. of Lines �.... .... ..... Length of each line......Z'O.f...... .. Total Length _4.4 .'*.............. D' Bax _ Type Filter Material . . .--.Depth Filter Material ...� .;..- ._.•.•._..•--�-••- k ` Proper Line .. .............. Distance to nearest: Well . ,__ ---- Foundation ... ...................• property SEEPAGE PIT Depth . o�� .... Diameter �.3..1.�.. Number . --.L......... ....... Rock Filled Yes [ No ❑ I Rock Size _ kWater Table Depth -----• ..(.�--------------•• •-- ... _....--- � � k ..... Distance to nearest: Well . . = Foundation .... .... ....... Prop. line --- .._--••-•- REPAIR/ADDITION(Prev. Sanitation Permit# ........ ............. • ------... - Date ... •--------- ) Septic Tank (Specify Requirements) . ---..--------------- fr ! ... ._. -t. . . ................... _Ae t Disposal Field (Specify Requirements) .-_- -- -----• --------- 4 ............. ......... . ..... ------ r' _..__... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will ba done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations 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, I shall nM employ any person in such mannar as to become ject to Workman's Compen ,ation laws of California." Signed .:._ ..��.�i -�1� ..-. ------ Owner .._.--. Title . .... .. . ...:.................. ......:............. ............... (If other than owner[ FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY .._._ DATE ...' ..f.b._ .?:.S-...• ....... ---- ..... - BUILDING PERMIT ISSUED .---..... - ............DATE ........:.........•--••---- -......---..... ADDITIONAL COMMENTS... �- - ...--_.- :.............. .............. � ----.- - ----------------::::::::::------ ----- -------- -------- :_-- .................................................... - Date f' Final Inspection b SAN JOAQUIN L&AI' 'HEALTH DISTRICT b 7/72 3 ►K