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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............. ....................................... .. Permit No. .7�:.9�Z (Complete in Triplicate) ................................ This Permit Expires I Year From Date Issued 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 compli with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ON :.. ..D d.-..---. ... ......_..rC...✓---- (4----- -------------------- --.......CENSUS TRACT .......................... Owner's Name ..... .4.!�E't. a -- -------------- ................ .........Phone ........ Address .------.3�P... ------ • ..... City . ......................... .......................... Contrdctor's Name ...... f... �.:.. .. --•License # _� GF..r"�^`_ Phone .............................. Installation will serve: Residence Apartment House] Commercial ❑Trailer Court C] Motel ❑Other .......................................=.... Number of living units:..... Number of bedrooms ......Garbage Grinder ............ Lot Size C�/4� _ _...Wat _...... Chaea,Suppiy: Public System and name -...... Private f0 �Y Iter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ O Hardpan ❑ Adobe .0 Fill Material ------------- 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 see age pit permitted if public sewer is available within 200 feet,) t 0 p /� s� PACKAGE TREATMENT [ ] SEPTIC TANK j ;-i - --1�__ ----../lC.,,��..__••--....---- Liquid Depth .. ................... r Capacity � Oa �- Type --- Material.t 'i ..x._. No. Compartments . Sa �.. Distance to nearest: Well -------- -------------- ••----.___Foundation .../..Q._.----_..... Prop. Line _—................ LEACHING LINENo. of Lines .!-9___-_ .. [ _ ..._..._. length of each )ine._.._4_Q._____•--------- Total Length ...)?-Q..._.......... 00 'D' Box ..__ ------ Type Filter Material ---46..�.......Depth Filter Material ._.. .................................. .........._: Property Distance to nearest: Well -----�,Q_-�......... Foundation ----_/_Ar p rty Line _,�..............:::.. SEEPAOE PIT [/� Depth ..._ .... Diameter _ '`._._- Number ..... 4?------_----- Rock Filled Yes No r w • Water Table Depth ..............L-0...........................Rock Size -?(-.. ............. � r Distance to nearest: Well ..........---ply._r_..---.......... Foundation ......J.P.. ...... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .............7----------- Date .................................. SepticTank (Specify Requirements) ------------------- --------------------------•------•--••-•--- .................•........................................................ . k DisposalField (Specify Requirements) ................................................................................................................--------- ------------ ------------------------------------------- - ----------------------------------------------------r..._....................... -----------•---------------------------------------------------- (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agonts signature certifies the following- "[ 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 Workm 's Compensation laws of California." Signed --- Owner By ,_. ..............•--_._... Poo '•... .. � - ;fitle ......_..- {If other than owner) f, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . '?^ 1 !......-- --•-- • ....................... DATE/Q �. .- t?"�............ - -----•------------- BUILDINGPERMIT ISSUED .....................-......................................................................----I—......DATE .....--=------= .......................... ADDITIONALCOMMENTS .._..--••-•-----•----------------------•--...............---......_.........----------------------.............................._.:...._... ........................•---------------:---...........:...........................................................-•-•------------•-------------•-------...-- ------. --- . •-- P' s! ................... Final Inspection by. ,, w. �� ..... 6 .. ......f` ................ ....�.- .--••• _... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'G8 Rev, 5M