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FOR OFFICE USE. / APPLICATION FOR SANITATION PERMIT - - Permit N��...:..,��l..... ....................................... (Complete in Triplicate) ......................... Date Issued This Permit Expires 1 Year From Date issued 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 No. 544 and existing Rules and Regulations: ! � p JOB ADDRESS/LOCATION - CENSUS TRACT ......................... Owner's Nameii/�.M..�_.Zy pY.. .Q«.... ..... ,................... Phone . ....... .� Address �j 1 Ci Ti'A_--- �. 6b �1It � �...... .. sem•--...l:x d.....------•--.. City �....... 5 Contractor's Name .- `` �t'�� .._.`F.Sfil .... license #l� '�� ..... Phone ` ��. 9,;q........- ..l7�lL. . i Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court 0 IMotel ❑Other ..------------------------------------------ Number of living units:.--I..---. Number of bedrooms ...4f.....Garbage Grinder ...._.-- --- Lot Size ................................. Water Supply: Public System and name .................................•............-- . - - Private$��_ 19 aracter of to a depth of 3 '❑feet: SandSilt❑ . ❑ El. Peat Sandy Loam {3 Ciway _ soil Hardpan F] Adobe (3 Fill Material ........-:-. If Yes,type _.._-__....--•..---..... t (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 seepa pit permitted if public sewer is available within 204 eet, Li p _ quid Depth ....�............... PACKAGE TREATMENT [ ] SEPTIC TANK i Size..Y _ ..tt------•...•--- -•-•- ` p • TypeP .CAs.T.. Material._ _n'�'-•••.. No. Compartments ..... ................ � r Ca aclty �..-. ... istonce tot nearest: Well ...1I��______.---••- , .. Pro Line ----..Foundation p �'� ..._........ 3 Length of each line.----- �•�-••-•-....... Total Length ---a`! 3-`____-� . LEACHING LINE [ No. of Lines --------------- - /�eA ...Depth Filter Material 'D' Box ../------- Type Filter Material - `rr .......--• Property Line Sn •-•-••--•-•• Distance tolnearest: Well .../r�.. ---•• Foundation .L4�---- SEEPAGE PIT E ] Depth ..........---------- Diameter ---------------- Number -. .____......--....--...... Rock Filled Yes [] No Q Water Table Depth --------------•--- ......••••• -.Rock Size ...................................... o r t Distance to nearest: Well .__...Foundation _.._. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation 'Permit#.................................. .......... Date ---------------------------------- I Septic Tank (Specify Requirements) .....................................---..-..-................ h Disposal Field (Specify Requirements) --•-----•-•-•-•-----••--•--•......................•------------------------.-------- •--••-.. . ............. ......................................... t ------ ------- l {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 v County Ordinances, State Laws, tiled Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. sed agents signature certifies the following: 'for which this permit is issued, 1 shall not employ any parson in such manner I certify that in the performance of the work as to become subject to Workman's Compensation laws of California." /�•.. ./..- i.---50- . --•---••-•-•------••---- . ..... Owner a Signed . n !u By . 3itle ---------••------- --------------------------------------------• (If Ae ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED;BY ........'!.R►.'..... ......... .............................. ........... .......I........... DATE ------------/1. 7 ----------- . BUILDING PERMIT ISSUED ' .........................DATE --...---------------------------........... ADDITIONAL COMMENTS ------------------------------------•-- -------- = ------------- Date . ............. k Final inspection b ............. .... . . ..�... SAN JOAQUIN LOCAL HEALTH DISTRICT _ - 7/72 3 M