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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ........ .......- ... .. .......................................... (Complete in Triplicate) Permit No. .._ ..... ... --• This Permit Expires i Year From Date Issued Hate Issued _l/>`:.��.. Application is hereby made to the San Joaquin Local Health District for a permit to cgnstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: I: JOB ADDRESS/LOCATION .. .. r �---�-�- .... y. -y�� -yl�� S.� ....CENSUS TRACT Owner's Name ... �/G ...�� ---, liZ._._.. . ------- ------•-..Phone ..D Z��t� Address /fes.. .. •"� j Contractor's Name t,Q.. �, ,4e46�,p -4 License �ItaZ,� `l/ phone Installation will serve: ResidenceXApartment House❑ Commercial ❑Trailer Court Motel ❑Other .... . ........ Number of living units:.. , . ... Number of bedrooms ...._Garbage Grinder Lot Size .................... - Water Supply: Public System and name . ------------------------ ... ----••----- ----•••Privet Character of soil to a depth of 3 feet: Sander Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑� Adobe ❑ 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK f I Size..._._.._.____-- :_ . .................. . .... Liquid Depth .......................... Capacity Type ----- - ------------ Material_..-..- No. Compartments ......................r_ Distance to nearest: Well . -- ........ -----Foundation Prop. Line .. LEACHING LINE [ ) No. of Lines Length of each line �3' � g Total Length Z.S_ /i D' Box `�✓ Type Filter Ma oriel 1� -__- Depth Filter Material Distance to nearest: Well .,_ -�jp-� 6/, rn f _ . .----.- Foundation ��_._...--- Prope ty Line . ._.Z .. .. SEEPAGE PIT p f ---- T [ ] Depth `y .._ - Diameter /. -.__ Rock Filled Yes No I - ----�•----... Number .... .. Water Table Depth .........:.... . ---•---•-----------------Rock Size ...- -...�................. A Distance to nearest: Well ..... --.-- Dd.._�_--_-._._.__Foundation ...- P �..__ Prop. Line .__. & REPAIR/ADDITION(Prev. Sanitation Permit# -------- ---- __._ Date ........................__ _••_-•) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) f --/5&�";7,::: c3.� .-ell X.,14247d, ..................... -----... . ..... ..... N .. . .... ........ .. .. . 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. Nome owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I s4oli net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . . Owner By . ,p _ Title , -iii-ether than ner} ow OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . BUILDING PERMIT ISSUED DATE —.♦J__�..� --- ADDITIONAL COMMENTS -- - -------- --- ------ - ... . - -- - .. . . ._DATE . . .................. ............... ......---- --...--------- ----.._-• ...---._ ....... . .... . ................ ..... ...- G�� ' �. _-----.._..------------------ .. --------------------------- Final Inspection by: . _ _ . ........ .... �-- --- - -• _ -- ----- -...., ---.....-------------Dote SAN JOAQUIN LOCAL HEALTH DISTRICT ..... E. H• 13 24 1-'68 Rev. 5M 7/77 u