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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) ---------------------------------------- P –�Sl7L -� Date Issued This Permit Expires 1 Year From Date Issued `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\-e�xi ting Rules and Regulations: JOB ADDRESS/LOC ION .__ `! ��------ -------1- ----------- CENSUS TRACT _- ------------ -------------------- -- Owner's Name --"-`- �- � G - " '------------.---------- - ------------------ Phone9�'�_ � Address ._ .CY7.7 - ----------. City _ �pN -----------.--- - ---- Contractor's Name ----" --- ----------••--�-- ------.License # - 1--------- Phone ----------- 0 Tc�f Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ❑ # Motel ❑Others `= ----------------------------- d � Number of living uni,ts _,l,_.--"" Number of bedrooms ___3-__.Garba. Grinder ------------ Lot Size _�_"_______ _ --�- 5------------ Water Supply: Public System and name ------------------------------------ • n ! 4 ------Private Character of soil to a depth of 3 feet:, Sand❑ Silt L] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam l Hardpan ❑ ' AdobeX Fill Material ------------ If yes,type _____--____________________ (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 tt..ank or seepage pit, -ermitted if public sewer is available within 200 feet) {n PACKAGE TREATMENT I ] SEPTIC,TANK Size-----15'__ _ --------------------------- Liquid Depth -._--.----- -kt,- o Capacity- /.-_ �----.--�TYPe - -- --- - ----,--- Material__�'"f'G•__ No. Compartments -----------------=---• Au N- Distance to nearest: Well ------ ` -----------------Foundation ___ ------------.Prop. Line _r�.....A-- -- h LEACHING LINENo. of Lines _r _ _ _ ___-- Length of each line--- -.,Total Length .......... 'D' Box - ✓Type.Filter Material - ____---Depth Filter Material -----1- ----------------------•--•- t /_�__------------kProperty Line i= ".'=------ Distance -to nearest: Well___SQ_____-_-__-_ Foundation ____ .. j% r r SEEPAGE PIT Depth_-: -------- Diameter'_1�3__'_____ Number ------ ---------------------_____ Rock�FilledYes No i0 Water Table Depth ------------------ ---- -------------- --------Rock Sizel_h_- - l-i__. '' S�'• Distance to nearest: Well ------- —-----------Foundation,_,=Q--f`____ Prop. Line --- I -------- Date ----------------------------.------1 Septic Tank {Specify Requirements)---- ---- -----""-- _-*--- --------------- -------_- t, Y ;. Disposal Field (Specify Requirements) ---------------------=--------------------------------------------------------------------------------------'-------•--------------- ---------------------------------------------------------- ------------ --------------------- -------------------------------------------- t (Draw existing and required addition on reverse side) I hereby certify that I have prepared this applicatiop4and than 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: ` "1 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."_ _ x Signed - Owner k By --- -------- - ------ ------------ - -- ----OL Title ---- -------- ------------------------------------ (If other th owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- --- ----------------------------------- . --- ---------------------------------------------------- DATE ------------- y��------------------- BUILDINGPERMIT .ISSUED — -------------------------------------------------->--------------DATE . --- ------------------------------------- ADDITIONALCOMMENTS -_"_----------------------------"------------------------- ---------------------------------------------------------------------- ---------- --- - ---------------------------------------------------------------------------------------------------- 1 .__-_""_______________-. __-_"".-__-_.__--_""____________________________"".________________"_________-__."_t_ti__J_{-"_"-___�----�________`-------_________--_--________-____-------____-_---__-___ . ___-.-"__________________________ ___ _ _ _. "____._ _ - - -- ----- Final Inspection by: -- ---------.Date _. -1; ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 .,.]-'68 Rev. 5M. `��