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FOR OFFICE USE: .-.... .... . APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ...741-`------- ................................... This Permit Expires 1 Year From Date Issued Date Issued .. .-6. 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. 549 and existing Rules and Regulations- JOB JOB AQDRESS/LOCATION . ..�o ._....... f..............I .._x............::......:.........................CENSUS TRACT ................ Owner's Name/j/ G/. -----------------------------•---............:.....................Phone .... lF* Address ....................... ��1�.......MZ A..!�'-! _.... ......................... City ....�eog!a.7 c/-3.•---••-----.............................. ..... Contractor's Name F. 1.__. _ ...........-........•..................License #A�V. �f� PhoneCV131P Installation will serve: - Residence (Apartment House❑ Commercial OTrailer Court C3 Y Motel ❑Other ............................................ Number of living units:... ...... Number of bedrooms _s_7�3.....Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ----------------------------------------•----•---------- ---------------------------------------------Private 19 Character of soil to a depth of 3 feet: Sand❑ . Silt❑ Clay ❑ Peat❑ Sandy Loam a Clay loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type _..._ ...................... (Plot pian, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or erm seepage e p•:t pitted if public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK t� Size---6?r. _r�.......................... liquid Depth ... .-_._.-- Capacity . ' ...... Type f W!..V. Material...................... No. Compartments ....... ............. stance to nearest: Well ...............................:....Foundation ...................... Prop. line ......... LEACHING LINENo. of Lines g i Total Length [ ---- �--------- Length line............. •---.. ..... �.-. D' Box f .... ...1--._-_ Type Filter Material f .. .Depth Filter Material ..................... d Distance to nearest:-Well ..: ?�:..:::�...•Foundation -A?.* ...... Property Line _� .............p DeptIl -.3 ----. ' Diameter��X1 -...... Number s:....:........... Rock Filled Yes ©- No ❑ ._.if_ - �.'!,�-afk Water Table Depth �P,� �..•..t....................Rock Size .p ..... Distance to nearest: ........................ Foundation .4. .'.......... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# Date Septic Tank (Specify Requirements) ....................-----------..................................I................ Disposal Field (Specify Requirements) ................................... .._..--•-- ---------------- --------------------------------- .......................................................... ......... ..................................................... (Draw existing and required addition on reverse side) 1 hereby certify, that I have prepared this application and that the work viii be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horn• ownfr or llc*n- sed agents signature certifies the following: "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 ...... ri..j��. --•--- ...... Owner .............:..................................... litle .......__..................._.._..-----•----._........_....._...----•--- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ._. DATE ....4:j5_---7 ,`�............. . ...... .. . ..... BUILDING PERMIT-ISSUED ................ ......................DATE ADDITIONALCOMMENTS ..................................................................................................................................:.......................... ..................................................................................................-............ ....... . _•*------------------------------------------------. ----- •-• -- ••. Final Inspection by: ................ .. .. ,.. . Date - `-�." -..-.......I.--•----• .........._.I.........I....._...-- ---- ----- ... SAN JOAQUIN L LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 7/72 3 M