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FOR OFFICE USE: D�jlc APPLICATION FOR-SANITATION PERMIT {Complete in Triplicate) Permit No. ...73............. ................................. ._ This Permit Expires ] Year From Date Issued Date Issued ...r�'� 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 withrCbunty,Ordinance No..-549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... .._,S,I :, ..1...F.r..........................................CENSUS TRACT ...... Owner's Name . . ...,-..�'�Z f.Eti�- ......_�.... ............Phone ..[ - Address ....... A _ff ... ••... --•............. .... City ..�1/+% .._.. ::.....:::. . .. ._ ...`/ Co ntractor's Name .._._..., .rf� rt _ � 1 �i ..........•................License # 0? 1 Installation will serve: Residence Apartment House C] Commercial ❑Trailer Court C] Motel []Other ............................................ Number of living units:.../_-.... Number,of bedrooms ..?,.--....Garbage Grinder Lot Size ...... Water Supply: Public System and name _Zt,,0&11,------A/4? e7� ..._ ...........................Private Character of soil to a depth of 3 feet:'-Sand 0 Silt I]- .'Clay Q_ '-Pilaf[� Sandy Loam 0 Clay Loam 0 i Hardpan ❑ Adobe, 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 tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT f SEPTIC TANK t ) Size................................................ Liquid Depth .......................... Capacity ----------- -- Type .................... Material...................... No. Compartments ....... -- �y Distance to nearest: Well ...........................Foundation ...................... Prop. Line ...................... LEACHING LINE ] Noi of Lines -_.......................... Length of each line.----------.--_. ._.....!^Total Length"'".._ '..:..'...._...-•--- � f] 'D' Box .............•Type Filter Material -----...............Depth Filter Material .............................I.....__,_.._.. !/ Distance to nearest: Well ......:...:............. Foundation ........................ Property Line ....__... -------------- 7 /SEEPAGE PIT ( j Depth _-:._---..•Diameter -{-------------- Number ...............:....... ... Rock-,Filled` Yes ❑ No CfJ- Water Table Depth � .........Rock Size Distance { p. to nearest: Well ._._ ..3 ._....... . ` REPAIR/ADDITION(Prev, Sanitation Permit# --------------- Date i Septic Tank (Specify Requirements) _______..... I bis sal Field (Specify Re uirements;.._•4V1Vd..._, ' `..'.�� _ _ -. � ._ ' /._� __------ ----- ---------------•-----..._..------------._...---- .........................---••--.................................................... (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 [icon- agents iignature•ceififies the following: "I certify that in the performance of the worfor which this pe`mit is issued k i• shall not employ any person in such manner as to become subject to Workman's Compwrisatlon laws of California," = k rSigned ................... :. ..................--•--- ........... . Owner t v � k . By .. -• .................. Title : .. (If er than owt er),� R PARTMENT USE ONLY 1 ,APPLICATION ACCEPTED BY_ •••--{ ...................-------I.............................. DATE ------• -•-- BUILDING PERMIT ISSUED ...1.... ..z-- . ...... ........................................._- ........DATE ---- --- ----- ._ ...... ..... .. ..... ADDI I ALMMENTS ......................... . = . • . ---•-----•_............... --.... .... f -• ...........................•---- • e ... . Final inspection by: Date , . . •--- ., J N LOCCAL.HEALTH DISTRICT E.H.13 24 1-'68 Rev. �' ` 7/72 3-M