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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued ate Issued 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 _L AY-,?_.1�----_ /^./ 1 1- ______r -.__-. L- CENSUS TRACT _---_-------------------- Owner's Name ----�4/- '- Q-/``-----. zll-/L�.-_l.,C,%:.L - _ Phone --------------------------------- Address --____ r. T f �z� - c - --------- City -� G%� �1------ --- -------------_-- Contractor's NameVie- ------_-____------------------------_-_License Phone xl� �f_ lJrz Installation will serve: Residence Q,,Kp�artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ----..--------- -- ------- Number of living units: /... Number of bedrooms . __--Garbage Grinder VV___ Lot Size __._..-._-_----___.___ Water Supply: Public System and name --_.------------------------------------------------ --------------- ------------------------ --------------Private JZ Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam,0 Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .... If yes,type --'.=_--__-___-_____- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must 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 _------_-...__ Capacity/,G,/,/,/--__ Typeaterial_dV1;>d_,-__ No. Compartments _`.............. Distance to nearest: Well �/.e_-_ ------------- ----Foundation ---lam_---------- Prop. Line ............. LEACHING LINE [ No. of Lines - -------------- Length of each line...>( g yy _ ______. Total Length 'D' 1-1 Type Filter Material d1[!..'�.Depth Filter Material /_1--- -Depth Distant to nearest: Well jCZ---------..-_- Foundation /,. _ ______ Property Line -- _.._............... SEEPAGE PIT [ ] Depth _ _- - __..--_.___ Diameter -- ------------- Number ------ ------------_...-.-- Rock Filled Yes ❑ No Cl Water Table Depth ..---------------------------------------Rock Size ...----------------------- Distance to nearest: Well -------------------_. ---_ -----Foundation ______ ----- 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 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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ___ Owner (If q r than owner ------------- -- ------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - -- - ---- ------ --- ---------- DATEd -%rf"6-- ------------------ BUILDING PERMIT ISSUED _.- ----- - ...... ------- ------ -- ---------------- -- - DATE .--__------------------------------ ADDITIONAL COMMENTS _ ---------- - ----------- -- - ------------- -- --- ---- -- -- ... ---- - - --- Final Inspection jfrytt - - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M