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FOR OFFICE USE: w APPLICATION FOR SANITATION PERMIT ..__....._.. jj 4Complete in Triplicate) Permit No. ..7�/—_& •_ " ............ . This Permit Expires 1 Year From Date Issued bate issued ..��•�3d;�y 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 Countx Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION Owner's Name � ,.,.- -;�.;4;;�;,�.;,.- -••••...............CENSLI5 TRACT ._.....:....... ....... .-- .......I... Address ,�_. a..�...5 ne ... _ P-- ... City ... P Contractor's Name / --- --- License ,5.... # ee� _r Phone'.... .......................... Installation will serve: Residence.[ Apartment-House fl Commercial'OTraller Court 0 Motel E]Other ....... Number of living units:.....r./. . Number of bedrooms ..__ ..__... _ Garbage Grinder ............ lot Sire . ............ .. . Water Supply: Public System and name ..... ..:.:.-----'•-..---:-_-• ••• .......... :••••-.-•••_•••__- \U •Sand Siit • Cla _• ------••-•---- -• _•---•-- -:.•.•••••_• _• •--_-�_-. '"' Character of soil to a depth of 3 feet. (� b y ❑ Peat❑ Sandy Loam { Clay Loam 0 Hardpan Adobe 0 Fill Material ------------ If yes, type ...- ---- f {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 Ifpublic sewer is available within 200 feet,) ' PACKAGE TREATMENT [ ] SEPTIC TANK v l Size:................. ............------.......... Liquid Depth .............. Capacity ---- - --- ------ Type ...-----••••...-•••• Material.--------- No. Compartments I . Distance to l nearest: Well ...... . ........... ... Foundation ........................ Prop. Line ...... .......... t LEACHING LINE [ J No. of Lines Length of each line. = ........ Total Length ------••---•-- • `D. Box ..----`..... Type Filter Material.......................Depth Filter Material ... •. .... . Distance to nearest: Well .................... � Foundation ............ Property Line SEEPAGE PIT [ ] . Depth _�..._--�. •••--------.. Diameter __.:---,-•--__-- Number _..---- •-„---- Rock Filled Yes [] Na [] Water Table Depth ..................Rock Size Distance to nearest. Well ............ Foundation .................... Prop. tine ................. i REPAIR/ADDITION(Prev. Sanitation Permit# ................. .............. Date ........................ - 17 . Septic Tank (Specify Requirements) ...............:..........................:....... .... . . ---------- --- ------•.........................................---........................ Disposal Field (Specify Requireencs) - -----------........................... -p_ .. :_1�_1_ +.. ---- •---- . . Draw existing and requires! addition on reverses ej -- --••----•...---•--•••. --•--••-• . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and' Rules and Regulations of the Son 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' Compensation law California.” Signed ....................... . Owner By ............................................. ----- Qjitle ............ .................... :...:.-...:....._._.. P (If other than owner) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY..............•. ..............••---....---••...... DATE .:... a-: --7 .._.. BUILDING PERMIT ISSUED ' DATE .• ADDITIONAL COMMENTS > 1.------------------------• -- •---.... ....................... ---------------------1......-----.......-- ..._.•.................. s .......... _..... ---------------------------------- _ '- - ------------- --------•-- ..........:_....:__---. •. --------••-•-••---... Final Inspection by: - t._... 00, •--- ... ;ase .._ `r7 " . ., .--- ----... z . x SAN JOAQUIN -LOCAL' HEALTH DISTRICT 1-'68 Rev. 5M _ •__ _