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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _.. ._.._........ ...................... J ................................... ... {Complete in Triplicate) 'j 7 -7c/ . ............ This Permit Expires I Year From Date Issued Date Issued .................... Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is :Wade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .......1.4.1141-• ��' •1��.�/ 1/C'.-- ::.....:;. :._CENSUS TRACT ..............:..... Owner's Name . . ... 4................................................ ................................. Phone ......,.. Address ..._.. . / � ----•------__ .............................................•... City t 1 'Xcr •--...... ....................... Contractor's Name ..�,l�,C.S...,mac i,� i�`1 �........ ........ License #� � ........ Phone Installation will serve: !1 Residence VAportment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ----------------------------------------- -- ` . Number of living units . Number of bedrooms __...Garbage Grinder _,1�Q-. lot SizelS ._.••--•----•-•-••• Water Supply: Publi and name .................. ...... Peat Sand Loam Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ❑ y ❑ Clay Loam ❑ V ' Hardpan ❑ AclobeX. Fill Material ............ If yes,type .....................-:----- (Plot plan, showing size of lot, location of. system in relation to wells, buildings,~etc. mustbe placed on reverse side.) O, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK j hSize..................................... : ........ Liquid Depth _..__..y.._..__....----• Capacity ..................... Type .................... Material.............--------- No. Compartments ----........ ...------. Distance to nearest: Well ----------..........................Foundation........................ Prop. Line .................... LEACHING LINE { ) No. of Lines ......................... Length of each line-........................... Total Length .............._..........._. 'D' Box ............ Type Filter Materiol --------------------Depth Filter Material .......................................... Distance to nearest: Well ......................... Foundation ............. ........... Property Line ........................ :,,N• . SEEPAGE PIT [ � Depth -------------------- Diameter ----•---` " ""'1�lumber: ...........................' �itockTF111ed"Ye ❑ Na ❑ Water Table Depth ........•'_.. .......Rock Size �.. Distance to nearest: Well .........................................Foundation .....-------------.. Prop. Line -_-_-------------•- REPAIR/ADDITION(Prev. Sanitation Permit# ...............---••••=........-............ Date .................................) t , Septic Tank (Specify Requirements) ............. -_----------`------------------.'_:i..,-.....`....................................................................... � Disposal Field (Specify Requirements) .- 5`=; .. .- �l✓'�..--- . . . /�� -------•........... --------- All .-_--------------- F ...-•------------------•---------------------------...........................•............... .------ ---------- .................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and` that the work wilLbe done. .in_accordance ith San Joaquin i 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." j Signed .......................:........ . _ ...--•---... Owner B g f._.!..... ..:- / ._... 1 Title -- ! �� ............................. Y (If other than owner) .0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. . . . . --------------------------- ........ DATE ....' I _aa-. .. ..._.....- ATE .. •........................... BUILDING PERMIT ISSUED ._ " ---`D — -- 6 ADDITIONALCOMMENTS .................................-------------------------------•-.---------------••--- ......._.. .....-----------........----:.._.............._......... E � ..................................................... .......... ..._......... ............... -- Date ._.. .......----• Final Inspection by: ..- ............................................... �.. .,7 SAN JOAQUIN LOCAL HEALTH DISTRICTAr ? i r w 13 241.1AR g.._ 7/723-M