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FOR OFFICE USE: ° r I - APPLICATION FOR SANITATION PERMIT -------------- - ------------- (Complete in Triplicate) Permit No:7_�__�_�'- -_� ___,_____ This Permit Expires f Year From Date Issued Date Issued _7/1__f'�.7_.1 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 comp lance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADpES /LO ATION --- ____CENSUS TRACT ""0' Owner's Name ".___ I , Address AL , �� - � :. - --- --- - ----Phone - - - ---- ---- - ------ . , , Ci Contractor's Name --_ " ------- f License # �n -S1-7- Phone Installation will serve: Residence Apartment House❑ Commercial❑Trailer Court ❑ i € Motel E] Other - J 7t Number of living units:----/----- Number of bedrooms___ _ — _Garbage Grinder_- -_:_.Lot Size, ----------------- __ Water Supply: Public System and name ________________________ i 1 _ ......................t--------------- -----Y;--------------"------------------Private E:-F. t Character of sol l to a depth of§Meet: Sand' .❑ - Clay Peat a I am j� Clay Loam ❑ f I Hard an Adobe' Fill Material __ ___ ____ If es, r ... y . Sand Lo ❑ - - � ., Y type - Y {Piot plan, showing size of lot, location of system ii in relation to wells, buildings, .etc.,must,be placed on reverse side.) NEW INSTALLATION: ' (No septic ta..n.k or seepage pit permpe y itted,if public sewer is pvaifa.ble,within 200 feet,] �� V PACKAGE TREATMENT [ SEPTIC 4ANK [ Size-- _f __} _ ________ _ _,• --_ Liquid Depth _.__.Yi _ __ --------- Capacity _f_� onType c- '� Material_ .L _ No. Compartments t :--------- ---- \ Distance to nearest: Well F f Q_1rFoundation -- •# ---.- - _ ----• --------- - 1��---------- _Prod. Line _�-------•------ NG LINE [ ( No. of Lines r-___.________ ------- Length of each line_____---- ------ --------------- , 'D' •I ---------------- LEACHING \ " Total Length ---------•----- , 'D' Box _' t -- Type Filter Material __ _�_ Depth Filter Material _. --_ / : -- - Distance to nearest: Well:•i�4__ ___________ Foundation ___f __ iProperty Line ___14-1.....--------- Z , SEEPAGE PIT Depth -_---------`Diameter.1 __ '_-. Number -------- Rock",,-- F• led Yes t ,Vo / I Water Table .Depth Rock Size i Distance to nearest: Well ------ _-99� Foundatio qq � . /�--------- Prop. Line ------t' ! REPAIR/ADDIVON(Pro}v. Sanitation.Permit#.,___•_____________ -_-„pate ___ .__ ---------- Septic --------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 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 whichathis permit is issued, I shall not employ any person in such manner as to becomes ject to Work n' Compensation laws of California." g --- Si ne - ------Owner By -.� (If other than w ---- ---�i - 'Title _.. FOR DEPARTMENT USE ONLY � APPLICATION '•ACCEPTED BY ""Y `" "--- -_ ' 4- ----------- = DATE .. -r f�--- ---------- BUILDING PERMIT ISSUED ------------ -- -----------------DATE -------------•------_-_-- TIONAL COMMENTS .___ -- - ------------------------ - ------ - --_- - --------------------------- a ---------- - -------- ------------------------- ------ ----- - __ ___ ________________----------------------------------- - ________________________ _______ Finallnspe ' __ ___ - ___ _- - _ �AN` JOAQUIN ��---------- - -----------=--- -Date _. .-- ------------�.--- ---- _ LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M r