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FOR OFFICE USE: ..............4 . . APPLICATION FOR SANITATION PERMIT ----.... .N Permit o ` (Cornpleta In Triplicate) .�- Perm ..7�_�� ........._d............................................ - - . �r. ... ......... .... This Permlt Expires 1 Year Prem Date Issued Date Issued .7:�l�:Tlr 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 Ordinance No. 549 and existing Rules and Regulations: ,/ r. JOB ADDRESS/LOCATION ...r .... R1� CENSUS TRACT Owner's Name _.W........... Phone Address ........... ... •. /'�- .F,..:... ...:..... :._....... Contractor's Name ----- c% s ..... u..... License # .0;:?7 C� 72 Phone - 52:. Installation will serve: Residence iff Apartment House] Commercial QTrailer Court 0 Motel [3 Other Number of living'unitsi-- ,/ ...Number of bedro ms � Garbage Grinder ..1141... Lot Size 1 79 �- . - ... ........ ......................... Water Supply. Public S stem and reams i Q .............. ,. ...Private Character of soil too depth of 3 feet: ,;Sond El Silt❑ Clay ❑t Peat Q Sandy Loam Q Clay Loam Q Hardpan 0 Adobe� Fitt Material ..__........ !f yes;type...,........... ............ (Plot plant, showing size of lot, location of system in'relation to wells, buildings, etc. must be placed on reverse side.) sl , NEW INSTALLATION: INo septic tank or seepage pit .permitted if public sewer is available within 200 feet] PACKAGE TREATMENT [ ] SEPTIC TANK f I V. • Size..................... , r ` :,. ...= = ....... Liquid Depth Ca aci ' ry No. Compartments p tY --------=----------• Type = Material. ........... ......... € Distance. to nearest:„Well ...Len.............t ...._✓ Foundation Prop. Line ...................... S LEACHING LINE - 4 ' No. of Lines Y gi'th:.af each-line :. `�............... Total Length 'D' Box Type Filter Material ------.Depth Filter Material Distance to nearest: Well -• .................Foundation ..................... Property Line .. SEEPAGE PIT ( ( Depth -------------------- Diamet`e'r, ------_------- Number ........... ................ Rock Filled Yes ❑ No (3 Water Table Depth ... I .Y... k Rock Size .......... Distance to nearest: Well =--...'Foundation ...................s o .j fir. _ - 1 . Septi ..... Tank Specify Requirements) . Disposal Field (Specify .Requirements) ?. . --•------------------•-----•--- .--... .F '� - .. .......................................... .................. -_•-"•------------------"---.....---.....-.__...i_..................... _..._-. ..-_- . -r (Draw existing and required addition on reverse side) i I hereby certify that I have prepared this application and th at .the-work.will.-bo-done-In-accordance with San Joaquin County Ordinances, Stato'Laws, and Rules and Regulations of the Son Joaquin Local Health;District. Horne owner or licen- sed agents signature certifies the•foilowing: . "I certify that in the perForinanre`of the work for'which#his permit Is issued, 1 shell not employ any person in such manner as to become sublect to Workman's Compensation laws of California:.” Signed ` ---- --- Own-------------•--. -... •----------- 1 - • er BY == - - --- ----- - --------�-.._ Title ---•- j... ....: i II other #hon owns L R D19PARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ..... �}...�.Z.-7 BUILDING PERMIT ISSUED -•---- - • _ DATE ........... ..... . ------------------------ ADDITIONAL COMMENTS _- - ---------------- .--- '- -----� f- '�--- -�- .7- ::: :--- -- = ... ... Final Inspection by: ............•• _-- _ �L'� Date ......-- g EH 13 21r 1-68 v• 5AN JOAQUIN LOCAL HEALTH DISTRICT $/ h 3M i