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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No_ --------------------------------------- ---- ------------------------ This Permit Expires I Year From Date Issued Date Issued -" -_- t 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. JOB ADDRESS/LOCATION --- =-0--- ---Z-Q------ -- -_Vc`_ ------------CENSUS TRACT ____ -`�7_�(::----_ f Owner's Name --- ---------- `�_�jl_Ll/_f]_� lrJ ------------------ -------Phone ---- /an/G= ------------ Address -- 'C.--- ------------------------------------------------- City _X-_ _CA�-- eW Contractor's Name __G'G-rd_J _ }L"------ h-----S ffPT/A_1_.1+94e # 4_$f2.437 Phone Installation will serve y Residence Apartment House,❑ Commercial:❑Trailer F Court ❑ Motel ❑Other Number of living units:__ .___ Number of bedrooms __S7----Garba e Grinder i!/o'--- Lot Size Water Supply: Public System and name --------------------------------------------------------- Private�c -- ----------------- Character of soil to a depth of 3 feet: Sand'❑ Silt:❑ Clay ❑ `Peat[] Sandy Loam 19 Clay Loam [] Hardpan Efrol,Adobe ❑ Fill Material _AD---- If yes,type ______________________-- (Plot plan, showing size of lot, location 1 of system .in relation to wells, buildings, etc, must be placed on reverse side.) { Q NEW INSTALLATION: [No septic atank or seepa permitted if public sewer is available within 200 feet,! W PACKAGE TREATMENT { ] SEPTIC TANK'[ - zQ0 ---O�l4 ,. /a1PL'�� - - - •----- - - --------- Liquid Depth - ---------------------- Capacity ----------- . : . Capacity / ------ Type _-- Materiaf_G'_f3NC-Ta._ Na. Compartments -_ ---- -----••-- stance to nearest: Well - 9k, _- _- _ --_--_--_ "•Foundation � -- --------- Prop. Line �- d -- /----------�--•=----•�' LEACHING LINE [ No. of Lines ______._ ,___-_----"__ Length of each line____--_._______-_ Total Length - --- D /&, If r 'D' Box - :- Type Filter Material e a__C'ADepth Filter Material -------1,-_ r Distance to nearest: Well ----- -------------- Foundation }---�----------_------ Property Line /O SEEPAGE PIT Depth _� �-_� Diameter - Number .-____ _.� Rock Filled Yes No i❑ r----- Water Table Depth _______. _ f_________________Rock Size Distance to nearest: Well �� __________ __________Foundation _____IV--------- Prop. Line _.._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------- } Septic Tank (Specify Requirements) -"----------------- Disposal Field (Specify Requirements) fi ---------------- --------------- ----------- -------------------------------------------------- T f _____ _________________________________________________________________ --------------------------------------------------------------------- -------------------------------------_-------------------_________________________________________________ i (Draw existing and required addition on reverse side) I I hereby certify that I have prepared this application and that the work will-be.. l 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 `t k as to become subject to Workm n's Compensation laws of California." cep Signed, sf yta �' r ------- -/�-*-- ----- Owner caner By ------�C_�J °� � --------•---------- ------------ Title ----- ---+ ° . $ {If other than owner) •� FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY _ -_Q '-------------------- --------------------- DATE ---- .:" BUILDING PERMIT ISSUED ______ ' _ } DATE ADDITIONAL COMMENTS _ -- - --- -------------------------------------------------------- ---------------- --------------------------------------- - ------- --------------------- ------------------------------------- ------- -------------------------------- ---------------- ---------------------- --------------- ----- - - - Inspect. b ---- - ----------------------------------------------- Final - Y Y----- --------- ate ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ti —.. s