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FOR OFFICE USE! APPLICATION FOR SANITATION PERMIT ....... ... .......... Permit No. .77..:_7 (! {Complete in Triplicate) This Permit Expires 1 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 compliance with unty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ! .1..._� .,...._. ... ........................CENSUS TRACT ................... -- - Owner's Name ..:.. N� _...._ .. .. ....... ....:........ Phone._...... ,1 Address ...... .�7 lfd ��. ... ..................... City _.: E'�1........................ .. ........................ Contractor's Name. - ... _ � ._. �v••Q' g.License #'� 8 � Phone .............................. I Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court El , Motel ❑Other -------------------------------------------- , Number of living units:---- ...... Number of bedrooms .....Garbage Grinder ............ Lot Size ..... f Water Supply: Public System and name ..... -_----- -----•-•-•-------------- --------...............Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy Peat❑ Sandy Loam ❑ . Cloy Loam ea - Hardpan ❑ Adobe ❑ Fill Material ............. If yes,type ............................ �- (Piot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f#1 Size....I� Z_�'�.....�-------.�-------------- Liquid Depth _.__ ..................... Capacity ...1. '�?..•. Type - ... Material.- = - No: Compartments ._ --............. Distance to nearest: Well ......_.�P.....................Foundation _./Ap.......... Prop. Line ..3�.............. f LEACHING LINE. [if/ No. of Lines -------- -------------- ----------- Length of each line.......1111�d......•------ Total Length _. .............. OV 'D' Box . r_____ Type Filter Material �--....Depth Filter,Material fes` p J/ - ,. . , Distance to nearest: Well ......��G'. ._..:... Foundation .....: Q-l...._.. Property Line .. ................. SEEPAGE PIT [ Depth .... - Diameter ._ ..... Number ..._..- ___..�_.... Rock Filled Yes No V - Water Table Depth .......... ........!....Rock'Size ...... . Distance to nearest: Well ..------1--.e Foundation ./Q............. Prop. line ........... � REPAIR/ADDITION{Prev. Sanitation Permit# ........ ................................,... Date .............-- .................. _ Septic Tank T ,{ �S ecifY Requirements) .. ... ......... ._ - - ......... Disposal Field (Specify Requirements) - ---- r'....... ... . - _._.....---- -------- ---- -- -- - - - ------- ----• ---- ; -- - ..:_.._....- ............. (Draw existing and required add itian 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 agents signature certifies the following: fz °'! certify that in the performance of the work for which this permit is issued, i shall not employ any person in such manner 1 as to become subject to Workma mpensation I s of California." Signed ----------------------------------- --- ---- ---------•--- . .. ---- - -------- ••----• . Own --_.. Title • ---_.._.---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �� DATE _._. ....................... ............ F ... BUILDINGPERMIT ISSUED ......_..---••..................................................................•••...._.._...............DATE --•--...............................I...... ADDITIONALCOMMENTS ...................................•--......------........_................-------------- ........................-.......... .......--........ ......... :------------------ --- :..... . .................................................... --•........................................ ........................................................................ .... ... .......... :.. Final Inspection by: .... ...Date^ ...f:�:-�- --.... ............?<?. r - SAN JOAQUIN -LOCAL HEALTH DISTRICT r wr 13 24 i.-A;t p.,,- 5M 7/72 3 M