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FOR OFFICE,USE: ; APPLICATION FOR SANITATION PERMIT ................................................. �Q (Complete in Triplicate) Permit No. . ...-. --. .. _.. This Permit Expires ] Year From Date Issued Date Issued ............... .. .... .. ................. . Application is hereby made to the Son Joaquiri•.Local Health District for a permit to construct and install the work herein described. This application is made in complian-ce with County'6rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... .r. ...... . _ .-...lJ° : CENSUS TRACT ....................::... 4- 2 Owner's NameG/ ...... ! "�� ----------•---- '1!I --J...-:. . Phone . Address ...................... ......_..- ........... City ��if�. ...................... .. Y .yam Contractor's Namer�!v '" � /> � .........License #a1: Phone `�� . .... - •- -- - .......... ............ C Installation will serve: Residence Apartment House Commercial [-]Trailer Court Motel ❑Other ........ ...... ....... .................... ' Number of living units:..... Number of bedrooms = � ---..Garbage Grinder�e�--- Lot Size Z.�f>�..�./12 ..............i� r / W Water Supply: Public System and name / ------lh/w/...................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ Pept❑ Sandy Loam fl Clay Loam aw Hardpan d. _"Adobe %- ill Material .........f:_ If yes,type (Plot plan, showing size of lot, location of.. system in--relation,tor''rniells, buildings, etc.., must be placed on reverse side.) k l• ,NEW INSTALLATION: (No septic tank-or seepage pit permitted if public sewer is available within 200 feet,) -PACKAGE TREATMENT [ ) ASEPTIC TANK[ ] Size.........................__:................... Liquid Depth .......................... t Capacity -------------------- Type -------------------. Material----------- '-------- No. Compartments -•................ _. " Distance to—nearest., Well .....Foundation -... Prop, Line `LEACHING LINE [ ] No, of lines ________________________ Length of eadi line._.______________..-..:.... Total Length _---- _-_--- ______._ ---- 'D' Box ------------ Type Filter Material ....................Depth Filter Material ---------. . ................ Distance (� Distance to nearest: Well ........................ Foundation .....--................. Property�Line ----------------.._.-.-: ' c . SEEPAGE PIT [ j Depth ............... Diameter ----------_--- Number ............................ Rock Filled Yes ❑ No i❑ Water Table Depth .......Rock Size Distance to nearest: Well.......:................................Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit 0 _.._..............-------------------------- Date .............--................... ) � Se tic Tank (Specify Requirements) - 7 11 ... ! _ . "................... ........ Dis osal Field (Specify Requirements) •-•'. -----. ---------------------- .........................................................---=----------- --•------•- ---------------------- ...... .... ............................................................... — ..............-.._.-------:......................................•--............... . (Draw existing and required addition on reverse side) 1 hereby certify,-that-l-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..wlilch this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." g ............... 3, Signed �er -------------- -- -- ...--------=--------------------•---------. Owner r r By .......-i--.-..... :`.......... . Title . ... ...................... . {If than owner)' f ° • r , FORD RT ENT USE ONLY APPLICATION ACCEPTED BY ... .. __ ...- : ...J........................................• DATE _,1 f1 .. ` ----------_-.. BUILDING PERMIT ISSUED .... .......:..............................•......--------.•----•--••---•- -----•.DATE .................... ---..- ADDITIONAL COMMENTS ............... .......................................... •-- ------ .. - = ...------- -------...-----•........................................--...............----------------...._.................... ..._.. -- -- Final Inspection by: *.._ ._ . - --------- ----------•--........Date y.._....:... ..... 91 /'* SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 241.'68 Rev. 5M ' — . _ _ -7/72 3 M