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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :................ .. .G..... Permit No. .7Y-2. .: 7�.. �' ' (Complete in Triplicate) tl� y............... . ..`.. ..:. ..:. Date Issued ._.S.'1.7�i� .. ........:..................I.......................... This Permit Expires } Year From Date Issued t� 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 mfade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,....._(.5.. - _,... t ��:. .__... .........CENSUS TRACT Owner's Name .. ....��__-�fl.Gyt4,,wrL ..Phone __5�77�7�3 ...... Address ... .......... .. r' -; ._._lt (�,�?. 1... ?sem.-----.._...'City ..-'• '. ...__.}....%_ -------......---•-•--..._ .......... �1 I - Contractor's Name .__-- :.C�,_-•• - ----- ... ,-s-----------License #a�J� s3.J...._ Phone .t4C Installation will serve: . Residence WApartment House Commercial ❑Trailer Court 0 MtelE] Other--------------------------------------------- Number of living units:......1--- jumberoo,f bedooms ..��,_.Garbage Grinder. ..................................................... ❑ \ Character of soil to a depth of 3 feet: Sand b Silt „IM['] Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ �1 k Hardpan Ad, a'be ❑ Fill Matertii .I ------- If yes, type ...................... ...... (Plot plop, showing 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 if public sewer is available within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TANK{ ] Size.......................... ..................... Liquid Depth .......................... CapacityI -------------------- Type ..................... Mdtenal.---••---•-••--•-----. No. Compartments ................... 1 1 - , Distance to nearest: Weil ......................... •-----_---Foundation _i-------_ ------ Prop. Line ...................... LEACHING LINE ] No. of Lines ----•................... Length of each line---_--•---.--..__...- ..... Total Length .................:..---..... 1 D' Box Type Filter Material ..........._:. DeptFi.Filtdr Material v Distance to nearest: Well ....ti ...._...... Foundation .. ......... Property Line ........................ SEEPAGE PIT Depth ... L?iarraeter ... :```Number .. ------------ _ ______ Rock Filled Yes C] No [l WaterfTable Depth -- • ...........R ck Size 1-4 Distance to nearest: We ..........................:------___-•. Foundation ....------•-.-_-.... Prop. Line :......----•-- ...... REPAIR/ADDITION(Prev. S�nitatton'Per""mit�#"....-........____..._..__-:r• ._.__. .. pate .•..•.......... ................•-) Septic Tank (Specify Requirements) �' t Disposal Field (Specify Requirements), Vis__ "..... r�aG� ......... - _.'- - ---..------XtO,- r�'''''" T'"'�" ........................ I -------------------------- ------- ----------- - ------------------------ -•-----• ----•-------------•---•- .....................-•----•--•------ ------.------------ ' (Draw existing and required addition on reverse side) 1 hereby certify that I have prepcired 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 far which thit permit is issued, I shall not'employ any person in such manner as to become subject to Workman's Compensation laws ofjCalifornia." Signed ....... _ Owner By . ........ ..W. 'Title .hQw-J ............... ............................ .....: (if other tnoner) F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY A_.� ----------- -......---•...................I.......................... DATE .......5— -f ... .......... BUILDING PERMIT ISSUED .... ............................................................ ....... --------DATE ....----..._.._......-- ...---....... ADDITIONALCOMMENTS ...-- ......................_..........._._.._._.....-•---.._........------••--------p......-----------..._.........._. _ k ........................................... . . --------- [..... ........----..._..... . -•-----:............ ........._._.._. ............_. ..---•--._..._...- --------------•- ----- ... .... .......................................--••-------••....-•--------••••-- --- ------.. . . .. ..... ..... Final Inspection by ............... Date .... ...=� ,lr ............... SAJOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 241-'68 Rev. 5M 7/72 3 M