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E ` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..7s. • ' 23 y Permit No. ---••- • . {Complete in Triplicate) .- � Date Issued .��'��•7 _.. -•---•..... This Permit Expires 1 Year From Date Issue e work rein Application is hereby mode to the San Joaquinrtro Local l Health It CounDi trice for ornce permit rmit to construct and and existing Rulestalnd hRegulat ons. described. This application is made in co p 0 .: .. . _.._ ".._.. . .....CENSUS TRACT .......................... JOB ADDRESS/LOCAT ._... .... . ...... / •� . _. .Phone Owner's Name _ ...... -r-��-Com................ _...__..... __...-- .�..� ir11/.✓J'-. ---- --- ------- CityJ Address c .v _�.. . ....._.. . Contractor's Name .�- �_44ei.e-�iL License # 1" 1..�,� Phone -•. ._a + 1•. installation will serve: Residence Pq Apartment House'[] Commercial ❑Troiler Court 0 Motel ❑Other ----- - --------------------------------- Number ---------- ------ ---- - rr _.__.Garbage Grinder '-'P_ Lot Size ..-- --- Number of living units: ........ Number of be roam Private ❑ --�-kyr.��.......................�-.............._..- ....... - Water Supply: Public System and name ...... -- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay loam ❑ Hardpan ❑ Adobe.�(J Fill Material .... . ..... If yes,type ------- {Plot plan, showing size of lot, location of system in relation to wens, buildings, etc. must be placed on reverse aide.# NEW INSTALLATION: {No septic tank or seepage pit pef'mitted if public sewer is available within 200 feet,[ 7� e; i3 •- Liquid Depth .......................... PACKAGE TREATMENT [ ] SEPTIC TANK�[ ��'� --� '��- Capacity . . . ... . Type ..... .......... ... Material.-.---.. . . No. Compartments ----------.••......... . Pro Line ------ ----- Distance to nearest: Weil foundation .� .- p l ZO Total Length ....... _.-O_..___••---• LEACHING LINE No. of Lines Length of each line .....7` - . ....- �r N - a ..De Depth Filter Material ...,�>- -. 'D' Box � Type Filter Material _� - - ---- p .� f_tJ foundationI---.----.-...--. Property line .. .--------- Distance to nearest: We ... N-- SEEPAGE PIT Depth Diameter Number ... / Rock Filled Yes k No Water Table Depth ! ........ . -----------...-Rock Size ...: ..`-,-•- --------------- L i i ��. ...---- Prop. Line Distance to nearest: Well(`.---.•. -- - - Foundation ... -- .- REPAIR/ADDITION(Prev. Sanitation Permit# .. ....... .... .. ---...- ----- Date ---------------- ----•1 Septic Tank (Specify Requirements) .. .---- -- --------- - ---_....----.... Disposal Field (Specify Requirements) .__.. ye.67 ............ ........ .... (Draw existing and required addition on reverse sie ll 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. Nome owner or licen- sed agents signature certifies the following: to an person in such manner "I certify that in the performance of the work Far which this permit is issued, I shall nqt employ y as to become subject to Workman's Compensation laws of California." Signed . . .. __....------- ---------- •-- Owner By t Title l ------•.... ... . .. . , .��,r.�-cam:._..�,,�.� ..�.d.�....... .......... T . . . �-�.�. (if other than owner) FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY . . _.. ._- .. DATE :. . ..................... BUILDING PERMIT ISSUED ..... . . ..... .... . DATE - . ._ ._....----- . - ADDITIONAL COMMENTS .. .............. . ................._. ....... -- . --- ... . ................. G� ........I........*Z_., 1 Final Inspection b SAN JOAQUIN LOCAL EALTH DISTRICT 7/72324