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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i Permit No. ....... {Complete in Triplicate) ................... l4- r .. . _ .� Date issued .........�..�� This Permit Expires I YearFrom 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 id`inance No; 549:`and-existing Rules and Regulations, ��/� ! � 14" . ..: ............................CENSUS TRACT ..........: ...--------- JOB ADDRESS/LOCATI.ON :... - .•-•------,/� Owner's Name . ./� <: - . f...:.................................................. ....:....----...... .-........Phone ...... ........ _. . . ....... elt Address ...... e° ,;f---......... ..... .-•......................•-•--...... City "' 0. ....... ...... ..... Contractor's Name /ear...- .......................4........License # • - - Phone installation will serve: JI? Residence ('Apartment House Commercial:❑Trailer Court 0 I ' ' ' Motel ❑Other Number of living units,../.......Number of bedrooms ..`�.....---Garbage Grinder ��... Lot Size � �: a. Private Character of soil to a depth of 3" .name -•---•-••-••••-------•---•--•................................... ..... Water Supply: Public System an .......................................... p feet: Sand 0 Silt❑ -Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam) � • ` Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type .............. •-- (Plot plan, showing size of iot, l cation ofsystem in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tahk-or seepage pit permitted if public sewer-is available within 200 feet,) Size..........................................11� ....... liquid Depth .......................... PACKAGE TREATMENT ( ] SEPTIC TANK-1 ] Capacity ..-:.....'. Type Material.::.....----•-... No. Compartments Distance to neatest: Well Foundation ...................... Prop. Line ................... . ....-•--...... . 4 - LEACHING LINE [ ] No. of Lines .. Length of each line............................. Total Lengt ..:.. _. 'D' Box ........ Type Filter Material .Depth Filter Material ............................................ Foundation Property Line + a-- Distance to nearest: Well� ��'�"""""""-""" � ` Depth �' .. Rock Filled • Yes 0 No 0 '�SEE:PAGE PIT { j p �..... Diameter .--�:........... Number .......................... WaterTable Depth 4 --••--- ......... ...............................Rock Size ................................. { .......Foundation ...._ Prop. Line ' Distance to nearest: Weii'................ ..._........... _...._.._...........-- REPAIR/ADDITION(Prev. Sanitation Permit+# ........................................ Date -I L Septic Tank (Specify Req irements) .............•--.... ----.... ---...... /y............. /(...... .. t - '1 k . • i� / L ....... ............. ..... Disposai-Field;(Specify ]iequirements) 4 �`r/=- .-•--- .. ....---V.. ................................................ ..__............f r . .............................t ..��--.. ..... . ........................... ................................ .... p a . ..-. exists....: {Draw existing and required addition on reverse side) 1 hereby certify that I havCpre ored'this application and that the work. will be done In accordance with San Joaquin County Qrdinances, State Laws, and Rules and`lEegulatlons of the San Joaquin Local Health District. Nome owner or iicen- sed agents signature certifies the following: -•-- —� "I certify that in the peiformance of the work for which this permit issued, i shall a employ any person In such manner 4 as to become subject to Workman's Compensation laws of California." Signed ..:........I .................I................ Title /� 1!s_i�'-.,......... I i. ther than owner).' k ' FOR Q11PARTMENT US ily . - : . ... .. .... .. . ..... .......... .......... ......... DATE ... ..:.a.. i APPLICATION ACCEPTED BY .....:....................'............................... ..................: ......,...,_DATE.. ..-.'.................................. BUILDING PERMIT ISSUED .........:. ' ADDITIONAL COMMENTS "-"" ............................................................................................... - .....- ........... ...... ............• .....------.......... ..........................�.�--= - ......... .... ------....................._.......---............_.._............. D ..... �.�, ...._......... i Ficial Inspection by: ate ..� p/ o SAN JOAWUIN LOCAL HEALTH DISTRICT F ,� 13' 24 i.-Ag 2'A - 5M 7/72 3 M