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FOR OFFICE USE: 't �I: APPLICATION FOR SANITATION PERMIT ........--- •--- ........ .......-,..... ........ �7— 5 .............. > (Complete in Triplicate) Permit No. ....... This Permit Expires 1 Year From Date Issued bate Issued .l.`,7, :;7 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 rho 'e in co pliance�with County Ordinances No. 549 and existing Rules and Regulations: J06 AQDRESS/LOCATION ..... . .. ..�_./'�lti ?.... ..�-----�C--.......CENSUS TRACT .�� ........ Owner's Name .--•.....---• fr_-7�► Jr'. ..�...... .........� �. _ --- ..........Phone . Address _. .. QQ...,.. �...�. � e� .............. City . +lr!11......................................... ............. F� Contractor's Name ... -��. Cts..s '�-[ - AV .............:.........`..License # .�C? s`�_ Phone f� � Installation will serve: Residence Apartment House❑ Commercial'❑Trailer Court ❑ ` Motel ❑Other ......:................ may, Number of living units:...--."....... Number of.bedrooms ..'Garbage,Grinder ..!!Xr�C�. Lot Size ;...2...�'' ,4ARA _ Water Supply: Public System and name ................. ..................... Private ._.P to Character of soil to a depth of 3 feet: Sand"'% , Silt❑�" Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ......................... {Piot .plan, snowing size of lot, location of.'system kin ,relat'ion'to..,wells,. buildings, etc. must be placed on reverse .side.} ... k NEW INSTALLATION: (No septic tonk'or seepage pit,permitted)f public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK°f � �frJ�/.t��f Size.................................:................. Liquid Depth ' Capacity ......_.i Type �aC?7�G:.....""Materlal.._elr�r . No. Compartments y _... ...t............... i Distance to nearest: "Well •:.......:............................Foundation _.. Prop. Line . LEACHING LINE ( j No. of Lines - ---- 1 yr Length of each f� line.-.....�.G........--- Total Length e-:. ................ 'D' Box .1------- Typer Filter Material .........Depth Filter Material .................::... Distance to nearest.-Well ...... Foundation ./U.' _�........ Property Line .p G ` lu L7f0 .. REPAIR/ADDITIO?4(Prev. Sanitation Permit�# - pate ....::................... i.. -••---•--•-----•.............. --- -1 Septic Tank (Specify Requirements) --------- i ..------- -..... C )DisposoI Fiel (Specify Requirements) . .. ..i 1?..-.._ "Q••_ ' .. ----- .... •-=-•............................. .........--•-- ........................ {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 agents signature certifies the following: 4 "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 . .......... ... -------------................ .........:.. ............ Owner ,f� By a (If other than owner) ` �FOR EPARTMENT USE ONLY APPLICATION ACCEPTED._I3Y ........ :•. DATE ..�/ .. ----- . .. -------------------•••......-------•........ BUILDING PERMIT ISSUED.............. ..........:.................. ... .......DATE ..... .---................................. , ADDITIONAL COMMENTS .. .......... ..................... ......... -------•-•--•.......:.........................:..........................................................----------- .. ----. _........ ......---------------....------•---...... ------------------ ------ ---•--- ............................................................... Final Inspection by: ....:.........• :- .......Date . .�" ....... . m'7.::............ ', SAN JOAQUIN LOCAL HEALTH DISTRICT E E. H:13 2.41-'68 Rev. 5M 7172 3 M