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.OR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................................. lComplete in Triplicate) Permit No. .. _: 6 .. This Permit Expires 1 Year From Date Issued Date Issued __:L.-P?....... 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 ......_.fS,,S~QS'e� . r CENSUS TRACT n ............:............. Owners Name .._._.__<..._1.. .'f..2_...L.Q----- Address `� J0 ...... . f... If- . .....iCity� �.� ....l Phone/y. .............. Contractor's Name 's {r... �� License �..W . Phone . Installation will serve: Residence[]Apartment House flCommercial oTrailer Court 0 Motel ❑Other Number of living units------- Number of bedrooms ------- -.Garbage Grinder ........... ......... _Lot I _....-- ......................... •-.•...................... ..... Water Supply: Public System and name ... . .�. ==:...Private ............ ❑ Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat 0 So cly Loam ❑ Clay loam Hardpan❑ Adobejk Fill Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK IM Size.. .................... Liquid Depth � .`.�.-•_--_-- ..... Capacity -�- o1a___--•- Typede--K ---• Material{A-4--Z. No. Compartments ----.;;............... Distance to ne est: Well _. � ................Foundation .1V............. Prop. Line ..................... -•--- -�. 0 1r �� LEACHING LINE• � No. of Lines _ ..=____-. ............. length of each line----------�...._..... Total Length ._..�`?_,::�............. 'D' Box .... Type Filter Materia6 .2,1, k'Depth Filter Material ----!Pr-f................................. Distance to nearest: Well ........................ Foun ation _.�..1.........__... Property Line ..._.-` ._•........ SEEPAGE PIT Depth _4P/...... Diameter ��- Number .....I..............------- hock Filled Yes bo No C) Water Table Depth � --Rock Size Distance to nearest: Well ...____..f,. .............. Foundation . Prop. Line REPAIR ADDITION(Prev. Sanitation Permit# �....................................... Date -------•.........--.----..--------) Septic Tank (Specify Requirements) ...........................................-...................................... - Disposal Field (Specify Requirements) ................... .............................................. ..................... ------------------------------------------------------------------------------------------------------------.........•-•................................ .............. ...---•...--•--•---•---•-----•_.. (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 wilh San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heallh;Oistrict. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, t shall not employ any person in such manner ._ _. kA_A,c r � _ laws o California. as to bec me sub ec't o Workman's Com �7t onl �} i Ip, Signed _._ice . r ---------- Z --------- xewnv y-- BY -----•----- •----•-•------- fir". ......... Yitle •u�c.Ut r� ----•- (1 other than owner) i FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __----.--- -. - • - --------------, DATE .... -.. .... __-- ....-. . . . BUILDING PERMIT ISSUED ---------------------- - ----- ----------------------------------------------------------- --_. _..._DATE ------- .............................. ADDITIONAL COMMENTS --- ----._ ------ ...--- -- -------------------- ... _... -- - -- ••--- ....----------- -- ....------- -- ---- - .r,.....---•--•---- ------------ - -•- ---- - .-...... ------------------------------------------------------------------------------------------ --------------- --------------------- ............. ----------- -- ------- -------------------------------•--•--------------•---•.._-.-.- --------.-.._-.. .... Final Inspection by: __. -.-•;------------------ _.....__..Date _... ��. .� --•-•----....---- EH 13 2 J-b fi SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M