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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT l�=' ......... ......... zs .. Permit No. .7�i1"....... � (Complete in Triplicate) h:........................ This Permit Expires 1 Year From Date issued Date Issued . 3 ..i45-, Application is hereby made to the San Joaquin Loco[ Health District for a permit to construct and install the work herein described. This application is machin•-compliani ee with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION Z. I----- /J.. - !Z, ---. j------------------------ ----CENSUS TRACT ......_...--- ........... �... Owner's Name ...... ........ ... ..... . ....1. __-�._. �.. .........,_....------------------------.-..._..Phone . 1�.f. fit. ....... Address .,...... ....y�._.._..- Y _.....��! '`.``.. .... ------------ City Do --•--...._o ...----.... ? J�'Conttactor's Nome . - 7T� - Installation will serve: Residence ❑Apartment House❑ Commercial ❑Troller Court ❑ - Motel ❑Other -------------- -------------........ .. Number of living units: --.�._. Number of bedrooms _.J......Garbage Grinder ....._,___ Lot Size ...... Water Supply: Public System and name --------------------------- -------• ....,.._. ..................................... ------------Private, . Character of soil to a depth of 3 feet: Sand I-] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe K 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 240 feet,) 1" irk PACK-AGE TREATMENT ( ] SEPTIC TANK. ] Size......<......................................... Liquid Depth ..........'•.`.�......... .. Capacity .. ._ Type __.__._..__......__ Material....... ...-. No. Compartments'`................. Distance .to nearest: Well .................................Foundation .....................�Pr p Line .........--_.._-_.---- LEACHING LINE [ ] No. of Lines Length of each line ... . 'iota! Length ..._...._... __ ......._. _.�_ ........... Type ..............DepthrFiite Material ............................ 'D' Box .__.-. ._.. T e Filter Material .__......._..... 1 Distance to nearest: Well ..................:...._ Foundation �. ........ ............. Property Line ........................ - SEEPAd-E PIT [ Depth Diameter .----------- . Number . .......................... Rock Filled Yes ❑ No ❑ Water Table Depth - - ...... Rock Size ..... : _ Distance to nearest'.- Wr I:I'. ..... ... ......Foundation _..-___..._�_._.... Prop Line .__.....__..._................ REPAR_ADITION(Prev. Sanitation Pe6hit#.............. ----.- ............... Date ....................... _ ) Septic Tank (Specify Requirements)=- ...... ............ .• -------•---.--/-----. ._._ ... j ` . Disposal Field (Specify Requirements)W .....�._...._.......aid A-.--------. . f...- . .4 N �7 e ... ....................................................... ....................................... .......................... .................................. .-"-' (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 a ccordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health'District. Home owner or liven- sed agents signature certifies the following: "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 ....... --. .---.—. .... ..._..� . .. .. ---�- •- -:�• -- ........... . .... .............. .-...._D.. ATE..-..--.-L../- {-.�. ......... ........ ..............- Title (If other t owner) OR fME T USEONL �"APPLtGATdON-ACCEPTED-BY . BUILDING PERMIT ISSUED _..DATE - -- ........................•. ---_--•--------•----- - ADDITIONAL COMMENTS -------------- ....... E. r-tip Ir. . -------------------- ............ rtt L $';tir ---------•............ ...... --- -- •. . --- :,_... .....--- .-- ------ --------- L Final Inspection by: ----... ........ ... . ....- -- ---------._...........................................Date } SAN JOAQUIN LOCAL HEALTH DISTRICT E. H:13 241='68 Rev. 5M .. - 7/723 ,4