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`FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT q - - --------------- - Permit No. 720.-_��_l , ----------I--------------------------------------------- (Complete in Triplicate( ___-_--______.._.__ _._-________-___ This Permit Expires 1 Year From Date Is AMA 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: JOBADDRESS/LOCATION l �y6_ _l G �-- _, +/------..i___ �.�-- ---CENSUS TRACT __-_s` ------------ Owner s _..___.____Owner's Name .*�!s + �' -2a��/ ----------------------- _--------------- -----Phone ------------------------------------ Address --k --------------------------------------------- city ---- --------------------------------------------------------- Contractor's --------- --- - Contractor's Name ��/'�j�? ''�� --------------------License # -------_-------------. Phone ------------------------------ Installation will serve. Residence ® House f❑ Commercial [-]Trailer Court ❑ Mote! ❑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 p ❑ ❑ y ❑ ❑ . Sandy Loam,] Clay-Loam,❑ W Hardpan ❑ Adobe'❑ Fill Material __________ If yes, type ----------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) I' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j F PACKAGE TREATMENT { ] SEPTIC TANK41 ---"----- -- - ------------------ Liquid Depth -y-• -....-•---�-•- - �Y Capacity ----- 7ypee�_ Material-----ix`s74&s.r : No. Compartments _ '_______________ Distanceto11hearest: Well ___> ---------------_-------Foundation _,/.P __-_________ Prop. Linea__-_-_____________ LEACHING LINE No. of Lines _____ __________________ Length of each line- -irp_-_-___--___._ Total Length i 'D' Box x? --- Type .Filter Material a___P1.._. . :Depth Filter Material ___1 Z --------- Distance _______Distance to nearest: Well _rp---------------- Foundation ----/-_Q--------------- Property Line ------------------- 4. - - i SEEPAGE PIT [ J Depth ------------------ Diameter ________________ Number . Rock Filled Yes ❑ No I❑ Water Table Depth}------------------------------------------------Rock Size -------------------------------- � Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line _-..---.____.._..----- f REPAIR/ADDITION(Prev. Sanitation Permit# --- ---------------------------------------- Date _______________._.-__.-.-..__--__-) SepticTank (Specify Requirements) -------------------------------------- -----------------------------------------------•-------------------.._-.-------------------- DisposalField (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. Nome owner or licen- sed agents signature certifies the following: "I certifythat ith n e performance of the work For which this permit is issued, I shall not employ any person in such manner as to b come subject to Workman`s • mpensati .h laws of California." t Sign ----------------- Owner ---.--_____ ________y___ ___ __ ____________ By ----- - - ---------------------------- Title ---------- ------------------------------------------------------------- (If other than owner) If FOR DEPA1tTMENT USE ONLY � APPLICATION ACCEPTED BY - . DATE _ _�1 Q_.' BUILDING PERMIT ISSUED --- ------' ` -- DATE ------------- - ADDITIONAL COMMENTS 1T" 'r ------- ------------------------------------ --------------- ----- _ -- O --- ------ Final Inspection by: --- Date�--- �J SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.,9 1-'68 Rev. 5M f