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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT rPermit No. ® (Complete in Triplicate) "` Date Issued p .'` ....... ...... .. This Permit Expires 1 Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District. for a permit l to construct and install the work herein described. This application is made In compliance with'County Ordinance No. 549 and existing Rules and Regulations: 1 y� -_-.. ... ..... s . . .. .CENSUS TRACT ............... ........ � J08 ADDRESS/LOCATION .��.�`..�` .._.;,.lf.�s�.,1�-••-- >- _, ..-. . : ._._. ......... . �. Owner's Name f �d ...:.... ...'. . . _ ../�............. Phone ................. Address .......�.�F'_ .. License # 2.,�' �,�:.: Phone . . � R��' ..... Contractor's Name ....... ..... � .._. Installation will serve: Residence Apartment House Commercial Q7rdiler Court Q j Motel Q Other ................•-••-•---•• •}-_..... ;�, 1, Number of living units:.��..... Number of bedrooms _... .. , .....Garbe a Grinder /�P--- Lot Size •� ...................... Water Supply: Public System and name ••..: ...,•••-•.....................-••••----•-----._................ ................... .........:-.._.Private Q Character of soil to a depth of 3 feet: Sand'Q Silt Q Clay E3 Peat Q Sandy Loam X Clay Loam Q Hardpan Q Adobe'Q Fill Material p.. �I_ If yes,type ............... (Plot'plan,ashowing 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-if4public sewer is available within 200 feet,) .. Liquid Depth .... PACKAGE TREATMENT. [ ] SEPTIC TANK� j Size - �:.• q P ` Material No. Compartments ` Capacity ............ .... Type ..•• ... ... ... Distance to nearest. Well .................. .!.i.. .....Foundaltion ...................... Prop. line .� LEACHING LINE e j No. of Lines .................. length of each line------------il.__ .......... Total,Length ............................ 'D' Box ............ Type Filter Material .. ................Depth Filter Material........................................ r Distance to nearest: Well . Foundation Property Line ....................... I a FI •. ... . [ ) p Diameter .•-•... ........ Number _.._..... -- --. -.._ D �� SEEPAGE Depth Rock Filled Yes No e. Water Table Depth Rock Siie ...._.._ 0 Distance to nearest: Well .........................................Foundation ...... .......... Prop. Line . REPAIR/ADDITION(Prev. Sanitation Permit# . ........ ...... .................... Date I� .__......... ----... . :) Septic Tank (Specify Requirements) ...•.... ... . ...• -� .................................. ' Disposal Field (Specify Requirements) i -- G `.:................ ..................................................------..... . -•••-•--••-•-•-•••-- ......................_.--- (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 Heo`Ith Diit6tt.Home owner or liten- I 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 Iawsf�alifornia." �f I Signed ... Owner By ...................... . �-...... ....... Title ... � �'� ��''ti. .. '�"..,, .._.......-•-.. (If er than owner) f FOR DEPARTMENT USE ONLY �; ----....... DATE ........ ......... APPLICATION ACCEPTED BY ... .... . ....... ......................... .. �� ... . BUILDING PERMIT ISSUED ..... ..._........j ................DATE ................ .......................... ADDITIONAL COMMENTS •-•-i ---•----•....................................... .............................. ............................................... --•---••--- ....................... �` �6- � ... ... Final Inspection by: _.. .. to . ._..... .. .................... SAN JOAQUIN LOCAL HEALTH DISTRACT ,I 7/72 3,L4 u 1.3 24 1_-an oe 9u► i