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r FOR OFFICE USE. ` APPLICATION FOR SANITATION PERMIT _....:... ..................... ......... Permit No. ...... ...........� N IComplete in Triplicatel 1, ......... ............................... Date issued This Permit Expires 1 Year From Date Issued .. ..ga-.7.3. Application is hereby made to the San Joaquin Local Health District for a permit to construct.an&.Jnstall~the work herein described. This application is made-1n compliance.with County,Ordinance No. 549 and existing Rules and.Re-0ulations: JOB ADDRESS/LOCATIO�N .... !.. ... . ....... :. g I-- ._ ..... ._. _:51�—......................CENSUS TRA .•....._..:.. - .. Owner's Name /`��i... 4 {,,1— i7. 9V a r ...Phone ........ Y1: Address .. . � --- ....................... -•--••--• City ...................:.... Contractor's Name .--/6916' - .�------ 1--....•---�-----•---- ------- -------------------License #o�ir� Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ g Motel ❑Other F - • - i Number of living units:._.____-. . Number of ro Garbage Grinder A/ .... Lot Size �Q -- .--- Water Supply: Public System and name.._ .._. ::.... .. .._ _ .. ................•-••---...__........................Private CDCharacter of soil to a depth of 3 feet:r Sand [] ilt❑ Clay eat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe lil Materiae.. If yes,type ............................ Plot plan, showing size of lot, location of,s. stem-in_relation_to.-wells, buildings, etc. must be placed on reverse side.] 1 ( p 9 � Y NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTICTANK,I!.) Size................................................ Liquid Depth .......................... Capacity-.......-:- `-- Type .......:........•... Material...................... No. Compartments ................. Distonce_to Nearest: Well ....................................Foundation---------------------_. rop . Line ...................... lin -LEACHING LINE [ ) No. of- es ....'.....:............. Length of each line._-._.:.---._--•---•........ Total Length 1 f 'D' Box Type Filter Material Depth Filter Material ,.:...,t„_•Distance tomearest: Well ......................... Foundation '_.... ............... Property Line ....................... SEEPAGE PIT [ ) Depth .....: .:: ........ Diameter ................ Number ....------ ........... stock Filled Yes ❑ No ❑ xWater Table Depth .:......:...........•._. Size '�. ------ t L .. . Distance to nearest: Well ........................... .. . ...Foundation -----.:............. Prop. Line ................ , REPAIR/ADDITION(Prev:'Sanitation Permit# ............................................ Date E..._.__.... ..................... Septic Tank (Specify Requirements) .." ....... ___ ---.._..�--•---•---.•--•-- J Disposal Field ,I. �ecify Requirements)'------- - -��------- .�_.: f - 1' -------------------------------------------- ------------------------- ----------•--•------------------------------.......................................................................... (Draw existing and required addition on reverse side) 1 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 iicen- zed agents signature certifies the following: "I certify that in the performance ofLthe 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 ........................ . ..........I....---• :.. Owner 4 4L.2-pe BY ............. , Title ....-.. .... /1.. !_.d� ._............•--• (If of r than owner} FOR D PARTMENT USE ONLY OK Z kAPPLICATION ACCEPTED BY ....... . ............ ... ..... ... ......................__................................ DATE .._ .... --/- ..... ..:.. .......... BUILDING PERMIT ISSUED .... ____-_.. DATE ............................................ ADDITIONAL COMMENTS .......,�r� � ��- -------•-----•--- -----------------•---•--•-•-----.-..........----......... _--_--------_---------- i -- ' s.i ....----------------------- ................................. ...... ._ .......---............_.............-...................................... ....- .3.............._. it Final inspection by. ........... . ....................... ........ ... ... .......^.__-••--•------..e......-----•---------................-----•-----..._.....Date ... - _ SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3-M y 13 24 t.�Aa rip.. Aws -