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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .�3�.�G:S.__.. �e (Complete in Triplicate) ...��:Via. -v,:+•K-� --.---..... �6�7 Date issued .-......._.'.7.:,�. „---,•• This Permit Expires ] Year From Date Issued Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein described, This application is made in-complionce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,:.:c:•-•--. __...--.. ............ CENSUS TRACT --............:...... ..... Owner's Name .............. , .- ,_.... Phone 1 Address �� --................................... City ---- ... i .. ' -..._.License # ` -�`l Phone Contractor's Name Installation will serve: Residence'J5[Aportment House Commercial:❑Trailer Court ❑ j Motel ❑Other .-_------------- ------- ................ Number of be -�-_-...Garbage Grinder---t "L0 Size .._ 1 ..-Xr ---•-••-•• 4 Number of living units:-. -... ` Water Supply: Public System and name ._. ...---6�4 ---------___....................j`.............................Private ❑ 5 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat'❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe V Fill Material _--........- If yes,type -------------_ ...... i (Plot.plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side) tic tank or seepage it permitted if public sewer is available within 244 feet) 1 NEW INSTALLATION: (No septic p� p PACKAGE TREATMENT ( ) SEPTIC TANK-[ ---------------------------- -------•-•- Liquid Depth -..-...............------� Capacity .................... Type .................... Material.-..-..--------------. No. Compartments ................... ; Distance to nearest: Well .......... .........................Foundation ..-_......_.. ....... Prop. Line ....._....... ....... � LEACHING LINE No. of Lines ..../_-. Length of each line.-- ._-............ Total Length ................... �F 'D' Box - -._ Type Filter Material _. ....Depth Filter Material - ....................r............. ' - Distance to nearest: Well .oV_-eV Foundation ...... Property Line ------------------------ 4 SEEPAGE PIT ]° Depth p .1-V ......... Diameter __ �...... Number ____/................... Rock Filled Yes No ❑ d ' ..r.............. Water Table Depth --1. .---•--..Rock Size .---:.. .. �. _ Foundation / Pro Line --- -------------- Distance to nearest: Well ..._ .._ .. �•••- p� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) --------------••------ ----------------............-............. .................- r ` Disposal Field (Specify Requirements) ---- • - - ------ .....••�r� ........- 4 --•...........................••-•--------- ------ --`-{ ------- ---------•---------------• ------- ..................._......................................------------- ------------- ..................... (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 licen- sed agents signature certifies the following: I "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 isle - -_ -----_-------------- ---------- BY ................ • ....... . ............ (if other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... .... ......... ............................ DATE ....�.b-1�-71 ------ .......... ' BUILDING PERMIT ISSUED ...4L.N------__ ---- -•--•----..'...---•-•----------•.......................•..--- --...........DATE ........................................... ADDITIONAL COMMENTS ..................... ........................•----------......--•--•-----......................................__........ -• ...-•-...F-----............ ...................................._.............. ............................................... ................... ........................•_'__'---_..`. p..._.............._..-----•---•-....................."----................'___... .. ................................... .... . .- ............._...__-_.--..._-_._........._...--------e .--•- --_-._... --•-------------*........__.......... - ... Final Inspection by: _.. ...Date .. ...................... SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 ,4