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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. . .�.`'----�.'... " - .. .... . ... This Permit Expires I Year From Date Issueo date Issued 6-L.`/'. 3 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 orad existing Rules and Regulations: JOB ADDRESS/LOCATION ..Cly . _t..._./_ --��":`'- ----..-_ __. __ . _..... CENSUS TRACT Owner's Name G?j <-1�.I-------/ IL- -C'Cr'-----_--•----..... i� l .-----•---•----...-----------------------...............Phone S Address ` 7 y /�'•zl��, c`c _< :. - 3.c. <: .. --------C' .................. Cit ----- ............ ................ Contractor's Name .. .. License ax:._`5. Phone ................ ........... Installation will serve: Residence®'Apartment House Commercial ❑TroilerCourt Motel❑Other .......... -• __---------- Number of living units:../.... Number of bedrooms ... ...._.Garbage Grinder ...____ Lot Size _ ---.-_=- --y{__................. Water Supply: Public System and name -------------•---•--- ---•----•------------•--...._....._--..---••-----_---•-•---•-•-••---------- ....... •-_Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan❑ Adobe ❑ Fill Material -----------. If yes,type ........................... (Plot plan, showing size of lot, location of. system ' relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ................. liquid Depth ....... C city .`.'.1.f :.._.. Type,:��L_-?-; Material............... .. No. Compartments .._ Distance to nearest: Well ... .........................Foundation .ZO.".......... Prop. Line .:. .............. � f LEACHING LINE — No, of lines ..`----_-.-_--- -- Length of each - ---------- Total length �i...._ ......... 'D' Box ... .-•... Type Filter Material Depth Filter Material ....f yr. �...............I......... . Distance to nearest: Well .......... Foundation .`t .............. Property line ....................... . SEEPAGE PIT [ ; Depth ...- ------ ------- Diameter ................ Number ............................ Rock Filled Yes ❑ No p 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 tris oppikation and that the work wilt be chane in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of user San Joagaiw local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the perfonvmnce of the work far which this pernat is issued, I shalt Mart employ any ponon in such mannec as to become subjecAo W kat Cotttpeiu0*M laws of CssRfoernia. er Signed ----------------------------- --- - Owner By ----... Title . ------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ / .1 Y1-.C.�..---- - - --- DATE .:... L.;. � BUILDING PERMIT ISSUED ...__..-------------- SSUED --•---_ --------------- ----------------------------------------- ..........................--DATE ...................------. ADDITIONAL COMMENTS • - - . . --------•--•------. .......•--•- . Final Ins - -� �_. • " ,l - .Date .. .... /.. .. . .- SAN JOAQUIN LOCAL HEALTH DISTOCT E. H. 13 24 1-'68 Rev. SM 7/72 3 X