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FOR OFFICE USE: [ -------------------- ---------------- .(Cb __3 0 APPLICATION 1FuR SANITATION PERMIT - - Co ._ .. __.._.». _ mit o. - -- ----- ------------------- l p ete in T p !cat 1 N �.. - . .._ .. Per 3-377 -m L ri l' ,: e � - ---- _______ This Permit Expires 1 Year From bate Issued Date Issued _.15 3 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 --_ _l7_._ pj 41,11 Q CENSUS TRACT Owner's -------------------------- Name _ ----- - -- ��-,��------------------------------------------------ ---------Phone -�•��----'��'-��3-- Address ._.. ---- I Ci Contractor's Name _.�lt�� ,.•_- JJ � Phone Installation will serve: Residence,VApartment House❑ Commercial :❑Trailer Court ❑ Motel ❑ Other -------- ---------------------------------- ; Number of living units:J_______ Number of bedrooms ._�_-_Garbo e Grinder -NO.._ Lot Size Ie�� 0 ---------- Water Supply: Public System and name --------------------------------------------------------- ----------------------------------------------------- ❑ Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay [I Peat❑ Sandy Loam E] Clay Loam;E] Hardpan ❑ AclobeJX.,`Fill Materia! ----- - -_ If yes, type ---------------------------- (Plot .-y_p_:_-------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must',be placed on reverse side.[ ►�. 1 NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ I SEPTIC TANK [ I Size------------------------------------------------ Liquid Depth ----------------------- Capacity -------------- -�----- Ca acit -------------------- � ---. P YTYPe -------------------- Material---------------------- No. Compartments ------•---------- Distance to nearest: Well -------------------------------_-Founclation --------_------_-----_ Prop. Line ----------.----- --•--- LEACHING LINE [ I No. of Lines ------------------------ Length of each line---------------------- ------ Total Length -----------------_-------- 'D' Box ------------ Type Filter Material ----------------- __________ __ ____Depth Filter Material - --------•------•------- Distance to nearest: Well _______________________ Foundation Pr6perty Line _____-- SEEPAGE PET -_ `- [ ] Depth --,-_t ---------__ Diameter----------------- Number - -------------------------- Rock Filled Yes ❑ No �— Water Table- Depth � Rock Size Distance to nearest: Well ,--_----------------------------------Foundation -------------------- Prop. Line ------------- REPAIR/ADDITION{Prev. Sanitation Permit# _______ _______________ ---- ------------ Date ---------- Septic Tank (Specify Requirements) ------------------------------------------------- Disposal Field (Specify Requirements) _____________'�Q__�_,� � _-_ } ------------ a'^11-43_J -" -- ----------------------------------- 9 ------------ ------------- - --------- f I ---------------------------- = -------------------------------------------------- 1 (Draw existin and required addition on reverse side) [ 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 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." - Signed ------------- Owner ---------------- --------- - BY ------- ------------------------ ----- ---------------- Title - - -- - - ---- -- - } (If other than ow r[ `� -� - -- - ------ --- - ------------ --- DEPA1iTMENV LISE ONLY - APPLICATION ACCEPTED BY _--- - ------ BUILDING PERMIT ISSUED --_ _-,- _ -- -- ----------- --------- -------- - ------------------ -----------------------------DATE ADDITIONAL COMMENTS _ _ __ ----------------------------- - ---------------------------------------------------------- ____________________________ _ _ ________________.______________.______._ ___________________________________________________________________________________________________________________________________________ Final Inspection by: _ -- Date ___-_ --- �- - --- - -- - - -- - - -- - - - ------------------ E. H, 73� JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R . 5M.