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F R OFF I E USE: APPLICATION FOR SANITATION PERMIT _ ;;� �. ' ..-.-. ..�. ...............• (Complete In Triplicate) Permit No. ...T.�.- �.. I Date Issued ...............--------.......-----------........... This Permit Expires 1 Year From Dale Issued Application is hereby made to the San Joaquin Local Health District for ❑ permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: t4.,r�%lV.�f. ..la:�:...::.:..:......� CENSUS TRACT JOB ADDRESS/LOCATION ..........--1.,5,x........ ._....... .................... fOwner's Name ...................#_4:r9.N... ,...... ...:......... one Z- Z-� Ph --••- Address _...-- City ��?-��!!.................. C .................... r................ • ...... Contractor's Name .--.-,1?.:..i�".�.. F}�2Rhf:S --- - ? �- 4•r-,„-----.License #AW.3.Y-3.. Phone Installation will serve: Residence l Apartment House•❑ Commercial ❑Troller Court Motel ❑Other ---------------_.......................... t Number of living units:.......f.... Number of bedrooms--...:..Garbage Grinder .---.. .---- Lot Size ._60.X... .............. � Water Supply: Public System and name ....... f• ...... ---•--------•............ . ..+.•--•-------•-f -------------:-.....----.....-....----Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loam ❑ Hardpan [] Adobe �iFili Materia) _'........_. If yes.type _-----...........•-....... (Plot plan, showing size of lot, location of system' in relation to wells, b{ildings,)etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank orFseepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK I 7 ] Size.•....---•••-•------ -------• Liquid Depth a . - Capacity _'-•_-- Type .................... Material.--............�..._. No. Compartments I P •-•---•............... N , ! �.1 1 Distance to nearest: Well ...'..._.-...-.- ......Foundation -...... Prop. Line LEACHING LINE [ ] No. of Lines ----------_----------7 Length of each line.—--------------- ........ Total Length ......_.... ................ 'D' Box ............ Type-Filter Mdterial ....................Depth Filter Material ...- --•_.- ................ Distance to nearest: Well •-------t-•----••-....... .,Foundat�ion'=..1...... . ............. Property tine ........................7 - SEEPAGE PIT [ ] Depth ..._...--•----...... 'Diameter ...-....._..'.- Number ....... .................... Rock Filled Yes ❑ No C2❑ Water Table Depth4`---••--••-••--k...... ................_'j`.Rock-Size .......... -••-•-••F----------• w Distance to nearest: Well ---------E..........................-Foundation ..:_......_`•:�'_'. Prop. Line .................. N , REPAIR/ADDITION(Prev. Sanitation Permit!# ........ _---_-----------------=- ----- Date ............ ..................... Septic Tank (Specify Requirements) -----------..........%............. Disposal Field (Specify Requirements) ... ... -"-- ------------ •- Cly,.-- ............................................................ . + tp ------------ ------------ { (Draw existing and required addition on reverse side) 1 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 Jo04uin Local Health District. dome owner or licen. sed agents signature certifies the following: i y "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 su ct to Work s Compensation laws of California." Signed .......... wn .......... t O er BY . title .. .---............................................ (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -.. :: :- '..1�__...•-----....... DATE ..... .. ---.-7.V BUILDING PERMIT ISSUED ......---•.. ........... DATE . ................ .................•....- ADDITIONAL COMMENTS -•----•............ ...................................................... .. .._.... ........... ................................... . .. .. ....... ...............I....................... ...........__..-•--......-,............_...._.. - ----------------- _-. .. 1. ... Fina inspection by. ............ •,.............Date SAN,JOAQ IN LOCAL HEALTH DISTRICT E_H._13 24 1268 Rev. 5M - 7/72 3 M