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44 f FOR>OFFICC USE:' APPLICATION FOR SANITATION PERMIT _... ....................... {Complete in Triplicate) Permit No: ..-7��~ 3Q. .................... .--....:_ '' ... ............... This P®rmit'Expires 1 Year From Date Issued bate Issued 3 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 Na. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ......Ifi _'i;; / lam.........:...............CENSUS TRACT ........_.......... .... Owner's Name __- mvs.............. .Phone ' Address -- 'f��-TQC _ ., 1�f *.................••--• .... ............ City .r" ...................... ................ Contractor's Name ............ ..•-•-------_-_------_License #e��!�s��.. Phone 34r4 �-�....��.. Installation will serve: Residence$Apartment House❑ Commercial ❑Trailer Court 0 'Motel ❑ Other ----------------------- ................ Number of living units:..Z.... Number of bedrooms __• ___.Garbage Grinder 11"A7_.. Lot Size . 1� .,, E,�'................ Water Supply: Public System-and.name.._,C.QhI _..hl�: ''__s�g� ___________________________________________•--Private ❑ Character,of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ '.i. '... 3 Hardpan ❑ ;,Adobe X Fill Material:__-__.,._... If,yes,type__________________________ (Plot plan, showing sizeof.lot, location of. system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKYd Size_ ..._ Liquid Depth _ �� q p ... .......... t Capacity,f ::... Type,:;:-.Material= �61_�a:.... No. Compartments _. —_._..._..... Distance to nearest: Well//-_____��-, -_ ---_--•.- ! .. .' - • --------------Foundation .:_./.�...__.----- Prop. Line ...f�_�..._______-•-• " LEACHING LINE No. of Lines -------14__ ..... Length of each line----eso$i . ....... Total)Length_X.!7e.'............... 'D' Box�,,.O$.. Type Filt7 Material 40 Depth Filter Material ` .............................:... k Distance to nearest: Well .... _.-�^-,_,_____ Foundation _.., t Jf ......... Property Line ....d ................ I SEEPAGE PIT K) Depth _- o4W........ Diameter ..c. .._. Number ----:�97-------,---------- Rock'-Filled YesJX No 0 E Water Table Depth ........ZX............... --------------Rock Size ..- -=--• d Distance to nearest: Well ........................................Foundation ......... drop. Line f ______••__ REPAIR/ADDITION(Prev. Sanitation;Permit Y# „----------------------------------- Date _,__,______......_..1..____.._.._..) Septic Tank (Specify Requirements) ..........__.................. ......................,,................................•--......... - ...... Disposal Field. (Specify Requirements) ....... .............. ------_---------------•-•• ..........--------------=-•-„----------------------•- .,.........-... �s ........................................ ............................................. ----------...............................I..--•------..__.�... -----------------------------_......---••--•----------------------. -__..-�-------,__,__----------_I.......... --------- {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. Home owner or licen- sed agents signature certifies the following: 1. ; "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 laws of California." Signed -------•--------- ...... .......... Owner By .......................... ...... . xltle - `'...............•-•...................., (If er than owner) FOR DEPARTMENT USE ONLY �;, APPLICATION ACCEPTED BY _-___... . . ........-•-- •-•--•...............•••-._. -•--............— DATE __..__... __L_ _...7.245-- BUILDING PERMIT ISSUED _..-----•...•-•-- ------------• .._.................. ..••• • DATE ................................. ADDITIONAL COMMENTS ...09 _ . /..__.__--- •,-_ .................. ............... ........... .i. --------- ----------------------------------------------------------- ..............................I.................. ...... .............................................. ........................................... .:.. ...-___._ ,,........._•__.._..._.___..__.......-»...__•____•------..................,__...... ,.._.___..______..._.. V Final inspection by: ....:. � _.Date .. _-• -� .�� --•__-.. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 24 1-'68 Rev. 5M 7/72 3 K