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t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .........................................._...._._..... (Comi$ ..7 `..� � to in Triplicate) ! ..................................................I..... Date issued ..�"-�:.�-.7•� IThis Permit Expires 1 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 compliance with County Ordi nce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._.. - G-�. .. ..---._c......._/.....• . �._.... ..................CENSUS TRACT .......................:.. Owner's Nome .......rt-,, C'4...3 '4t_V .............Phone .................................... Address _ 9.x.3.1_..:_ .� ._ ... _---- :. ..._........... City __.--------- ' _. =:.:..:.:.. ... Contractor's Name 1 _.License # ..... .................... •.................. Phone .......... ................................. cam.........................❑---------- ❑ Installation will serve: s R€,Kid�5ce" A �rtment House Commercial Trailer Court ] I Motel ❑Other Number of living units:..... ..__._ Number–of—bedrooms _3.........Garbage.Grinder ............ Lot Size, --_-.--__ ................................ Water Supply: Public System and noire` =-i ._.: ------. = - Private ❑ Character of soil to a depth'of 34eet: : Sand❑ Silt❑i Clay ❑ `Peat❑ Sandy Loam {Clay loam ❑ Hardpan ❑ Adobe 0•-,FiiiiMaterial _..._._:.... If yes, type -------------------_------ � (Plot plan, 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,) 3 PACKAGE TREATMENT [ ) ,'SEPTIC TANK I I Size......L. .. ...................... .............. Liquid Depth .--------- -- 00 Capacity .................... Type ............... aterial-------•----••--...... No. Compartments ...:..........:....... Distance to near.est: Well _ :._.....-..................Foundation ................. ... Prop. Line ...._................. ,....•...—Ov _. s-,-- --�'Length of each line.........--•---....._ ti LEACHING LINE [ '] : .No. of"LEnes -------------------•---- 9 ---...: Leg ._. .......... Total nth Dox,,. Type Filter Materia# .Depth Filter Material Distonce to nearest: Well ........................ Foundation ...____....... --------- Property Line ........................ SEEPAGE PIT [ j Depth Diameter ................ Number ------- .................... Rock Filled Yes C] No Water Table:Depth .Rock Size Distance to nearest: Well ........................................Foundation ....._ ------------- Prop. `Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit 0 ----•---_---- _------...---• •--------- Date .................................. Septic T nk (�cify Requirements) _........__.s f �e! - r �� 't�^a�...../2c>4 [� ...............-...... M Disposa"I gield ;specify Requirements) ---... ./ / = .._.... ii •-----•..........•-------I..............................-----•....._-_.......----•----•---._...---•------...---.....--•••-----._._.•----------_..•----••---•------_......_._....._._...... ............... .................. ............................................................----------------------------------........................................................... , - r (Draw existing and required addition an reverse side) 1 hereby certify that I have prepared�tl is application and that the work will be done in accordance with San Joaquin Rules and Regulations of the San Joaquin local Health District. Home owner or licen- County Ordinances, State Laws, and 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' Compensation laws of California." 7v.�---......I.....-•--.... - Owner 4 y� , Signed . r By --- E _.. : �� . Title . (if other than owned l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ---- ------ •---• -------- ................... ................ DATE ...... G.- 7.r`I ---- BUILDING PERMIT ISSUED -------- ---- .......................` _� --•--....... .... ----•••--- ... •-----._-DATE ....._._..-•-•--..:_... __-----_._._....- ADDITIONAL COMMENTS ..7o...L �.. sc %!:, ... mt�+ ..................... __..... ____•...........................................................................................................................................................................................I_-----_ - I ti'.._.._•---•------•-- •...................................................................................... ...................._ ................... Final inspection by: ..... :................................................•----...Date ..: „ n .SAN.JOAQUIN LOCAL HEALTH DISTRICT C 13 24 o..., cA.a _ 7/72 3 M