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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............... ...............I....................... ..Permit No. ..- o (Complete in Triplicate) •.. ........................ pp This Permit Expires 1 Year From Onto Issued Date Issued p. :A7/ . 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 compZ with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOC ION vc.-Y. /..-0�S_ .. ..._-.��c. �J. .......CENSUS TRA .-- ........... Owner's Name / ' /P t..G..le... ..../V I/_4Zal--.-----.-.1}.�............. Phon ... .- .a., .... AddressCity ------------ --------•---....................._._......... Contractor's Name .. _.._ - -•----- - ...... i _. ... .. �•' r.. _ . - License # ........ .......�� ---- Installation will serve: ResidenceJ2�Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other -------- Number -- -Number of living units: . L.--- . Number of bedrooms _, ------Garbage Grinder/%C. .S _ Lot Size .Q.�_.. ._.1�..[x. ...... Water Supply: Public System and name • - --•-_-•-- • -------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan Or Adobe ❑ Fill Material -._- . , -.- If yes,type ----- .. IN& 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 [ ] SEPTICTANKT J Size----------------------•-----.---........-_ ... . Liquid Depth ................--.._.----� Capacity Type --------- --- ----- Material CfAI c o_ 7' No. Compartments ... ,....... Distance to nearest: Well 1,� ..... .................Foundation _o2ko _. . _ , f Prop. Line __-- ---�'.Q.._.... 4tft D LEACHING LINE [ ] No. of Lines ok Length of each line 1.00 i - . ... ...- Total Length ......I.... 'D' Box /.. Type Filter Materia170_e..`C...Depth Filter Material ...a ............. ..__._...._....... Z r Distance to nearest: Well ... .................... Foundation .........._...._ Property Line ........................ n SEEPAGE PIT ( ] Depth ....... Diameter Number .- Rock Filled Yes [K No ❑ V Water Table Depth -----------.............•--.....-..----..---.---Rock Size .... ............ Distance to nearest: Well ... `>j'0________________________Foundation I _ S. .._... Prop. Line . _..__... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ... ........ ..................... Date ....._.._._.... ................. fi Septic Tank (Specify Requirements) --------------------------------------...... ............._._................ Disposal Field (Specify Requirements) --------------------------------------- ..........................---------- --------------- ........ ...... (Draw existing and required addition an 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 followi g: "I certify that in the performance of t work for whioh this permit is issued, I shall not employ any person in such manner as to b to a subject to an"s mpensatio I ws of California." Signed _ Owner By rifif Title . ................ .. ... r an owner) ..s FOR DEPARIIMFNT USE ONLY APPLICATION ACCEPTED BY DATE BUILDING PERMIT ISSUED ... ._. � . .. ... _ ._DATE . . ...................../........... ADDITIONAL COMMENTS .... .. G ` ------------- ----------------- ----------------------------------•---------- -.. .. ................. .....---------- --------- ---. ---------. -----•------ --------------------------------- ----------- ----------- Inspection b P Y: ...- .. ... .. Dote - f- Final Ins SAN JOAQUIN LOCAL HEALTH DISTRICT 1-'68 Rev. 5M 7172-3 �1