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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 00000(/ 9 S- ��3 Permit No.�_........ . ` (Complete in Triplicate) -.-..•. ................. .•-_..-_.--,--- ...-.- This Permit Expires 1 Year From Dot*Issued Date Issued .1...1`....:r 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/LOCATIO T�O. _ _ ..................CENSUS TRACT ..................._.._... /� - _. .. . Owner's Name _.... --- . G_ . .-.. .,....._LB-r.......................... .. ....... .......Phone .4/7 -.*7.,? ......... Address _ 1.. -� � (!.._. ,(�-C)- �t�t.. ...... city ....................................... p Contractor's Nome ..._ .---5 '(,Q�................License ` ` ��.:. Phone .LQ .._..f ..4 ........ Installation will serve: Residence Apartment House❑ Commercial ❑Troller Court ;❑ Motel ❑Other .. _ . .- ..._------- ................. Number of living units: _. . Number of bedrooms .......Garbage Grinder o Size _....`r� - S .......... Water Supply: Public System and nome ------_......... ----. .. .. .._...._ .............. .----------....Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom Hardpan ❑ Adobe Fill Material If ye;,type ...... ___ -_._..._-. . (Plot plan, showing size of lot, location of-system 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 [ )' SEPTICTAINK :ze. - -.x- __.._. _.: _. Liquid Depth ...............r Capacity Type :/� _- _..- Ntateriol. '-.- No. Compartments ...� :.. ......! Distance to neorest---Well - _ _ -_._..._..._...Foundation 0_�_.._.:.. Prop. Line ..... _..._.... '�-- _ --- LEACHING LINE t� No. of Lines Length of each line _ . ' -.- Total Length IF LEACHING Z 'D' Box v Type Filter Material -.ki ....Depth Filter Material _ 1.4.. _......_............... i Distance to nearest: Well .-- .............. Foundation /Q Property Line _..��................ SEEPAGE PIT ( Depth Diameter ��.. Number __ ?/ _.- _. Rock Filled Yes No [ � Water Table Depth ._._.. :.. ---................................Rock Size -- - ---- --�. '----• Distance to nearest: Well _ . .................._.._........._Foundation . .. lQ Prop. Line ....! ............... REPAIR/ADDITION(Prev. Sanitation Permit# -----_.. _. _._-_ _.-. _..._........_ Date ........................._---__..) Septic Tank (Specify Requirements) _ ' Disposal Field (Specify Requirements) ------------- - -....--------•. ------- --- --.:------ --- _ .. ---- - _ - -- -------- --- ----- -----... ..... ----- --- --- ---- _ -- ---- -- ---- ..._.... .... - .......... .... -- ---- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be slue in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoolth 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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . _ . _.. ...... ------- Owner By . .. ` ._. ._ Jitle (If oth r han owner) F�r JIM RTME T USE ONLY APPLICATION ACCEPTEDATE - BUILDING PERMIT ISSUED . _. , /DATE .......... ADDITIONAL COMMENTS ..... .. , .. . ....... ....... ...... .. :,,�. .... . .. .... Final Inspection by. .._._ _ � 4- .- j. . . C��ii�-. - � .. ... ......... ............Date . .-..17. ...�._..f'. ......�: .l' SAN JOAQUIN L L HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M � 7/72 3 M