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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT q .......-. Permit No. ��:. o/... �- ��-�� (Complete in Triplicate) Date Issued res ....................... This Permit Expires 1 Year From Date 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 .............. :11.34�J:p....... 'z . 4: S. ....................CENSU5 TRACT ....................------ Owner's Name P,0.7-T�,7 :............................................................................•-•--..........Phone .................................... ........... . Address ---------•-----`.-- .... e . ..- ety vG. . . ................................. � . J� � Contractor's Name ......., / # Phone ............... License Installation will serve: Residence (XApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:...:!...... Number of bedrooms .........Garbage Grinder ............ Lot Size .:......... ............................ Water Supply: Public System and name ......................................................... ..••---.••......................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat Sand Loam N' Clay Loam D Hardpan❑ Adobe ❑ Fill Material ............ If yes,type ............................ (Plot pian, 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,) ,, �/ 1.ye• qK.1�................. Liquid Depth .....��....... PACKAGE TREATMENT [ ] SEPTIC TANK� ] Siae:�._...� q p Capacity 6?9.. Type 10 Material No. Compartments 13............. Distance to nearest: Well .,Foundation .......... Prop. Line ..... ....... 100 all LEACHING LINE [ j No. of Lines ....6)................ Length of'ach ll e. l..l'.......-_.--..----- Total length 19... 'D' Box ....J...... Type Filter Material .��X6...S•Depth Filter Material ....,f ........... .•. ............. Foundation -.s :._. ........ Property Line ....15� .......... Distance to nearest: Well ,�l-C`�. SEEPAGE PIT [ ) Depth .................... Diameter ................ Number _.....................::.... Rock Filled Yes ❑ No ❑ • 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 1 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 Son 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 orkman's C mpensation laws of California." Signed ............�/�- �l ............................................. Owner r ---�--�- BY .. .. .. ................................... ....................................................... Title .............. ................................................... (If other than owner) FOR DEPARTMENT USE ONLY w APPLICATION ACCEPTED BY y_ ....�4 ,r... ... DATE , `l�. . �.�...:..:.�2............. BUILDING PERMIT ISSUED .......DATE t ADDITIONALCOMMENTS ....................................•---._..........----...-•-.......---............................................................. ...............................................................•---.......-----......................................................................--------....--•-.._............... ....................................................... :......... .....---•--...................._.. ------ -.................................................. - ,i/. -Date :�1:...� .....� Final Inspection by: ,/�1.... ,f ..,f.. s......................................... . ........... t!/ ............. ......... .. { .........._. ..................... . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13, 241-'68 Rev. 5M 7/72 3 M