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` A <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> _...._.............._. �� .7.�/.�...3........ <br /> (Complete in Triplicate) Permit No. <br /> ...................................................... This Permit Expires 1 Year From Date Issued <br /> Date Issued . .. 'z(/ <br /> Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> f1r _ <br /> JOB ADDRESS/LOCATION ........� .��'..✓.a�.........., .1.! arP�....taco!�y...................CENSUS TRACT .....................�... <br /> Owner's Name .. f '...... .7.-,g .j.5.... ../7...4}:.�./...... A.f�.1�=j-.1 ..Ii:�. Phone .����.�.��1..... <br /> � ! ' <br /> Address _...... . . . .. .��?.1... ..4.J� .l.:ita......ir:! .......................... City -en. <br /> /I .. .... <br /> Contractor's Name ....... ............................................License # . ... Phone <br /> Installation will serve: Residence W Apartment House 0 Commercial QTrailer Court 0 <br /> Motel ❑Other ............................................ <br /> Number of living units:..../....... Number of bedrooms .,......Garbage Grinder ............ Lot Size ..-3/................................... <br /> Water Supply: Public System and name ..............................................................................................................Private (�► <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ;Z Clay Loam ❑ <br /> Hardpan❑ Adobe ❑ Fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) v <br /> PACKAGE TREATMENT [ ] SEPTIC TANK-[ ] Size................................................ Liquid Depth .......................... lv <br /> Capacity .................... Type .................... Material...................... No. Compartments ...................... lam' <br /> Distance to nearest: Well ...........Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE [ ] No. of Lines ........................ Length of each line............................. Total length ............................ <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ........................ Foundation ........................ Property Line <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes [3 No C] <br /> Water Table Depth ............,.Rock Size <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) 4244-v...6-: .....1TAe A........... <br /> Disposal Field (Specify Requirements) ........ U..1. ..F./.........,,L.G .......................................... <br /> .........................................•••-••..........•----.--••••.3.04`1-t........................ :�._...............•... <br /> ............................. ..................... ........................................................_.................................................... ....................................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that 1 have prepared this application and that the work will be don* in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and.Regulations of the San Joaquin Local Health District.Home owner or licew <br /> sed agents signature certifies the following: <br /> °9 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subjec o orkma s Compensation laws of California... <br /> Signed ................. Owner <br /> ...............•--------.......................... Title ........................................................................ <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ 1.. . .�a�.......................................................... DATE .....�'."=z.43."�j4'....... <br /> BUILDING PERMIT ISSUED ..............................DATE ........................................... <br /> ADDITIONALCOMMENTS .................................................................._.........---............................................................................... <br /> .......................................................................................................................................................................................................... <br /> -•-•-------•......................................................................................................•-•--..............-•------....................................._....................... <br /> ................................................ .................................. <br /> - Final Inspection b ...................Date ..... ....... ............. ........... _ <br /> SAN JOAQUIN LOCAL.,HEALTH DISTRICT Ca <br /> E.H.13 241-' 8 Rev. 5M 7/72 3 <br />