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FOR OFFICE USE: r _.................. APPLICATION FOR SANITATION PERMIT - 39s-"•-••-.• {Complete in Triplicate) Permit No. ...... ..y`. ...... . ..I................. .5..:�� 7, ...... This Permit Expires 1 Year From Date Issued 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��o5np rp ce with County Ordinance No. 549 and existing Rules and Regulations: A � ;� O JOB ADDRESS LOCATION CENSUS TRACT .......................... i ......._.._.._ _.:.�.u :.ru.. ��. Owner's Name Y... .? -.... .i`}S� ...............................•.............. . Phone .. SIR_ ' Address ...._...._. .... City �.:........ ........ �Z.f.?..a�. Contractor's Name .__...._... ...j-' u.��,;. ,t/'....................................License# Installation will serve: Residence®Apartment House's Commerciol ❑Trailer Court 0 s Motel [:]Other ------------------------ •-------•-•--•--- Number of living units:...... ..___ Number of bedrooms .... .....Garbage Grinder ............ Lot Size .....-�^. .........:.:... Water Supply: Public_System-and.name._....... Character of soil to a depth of 3 feet Sand 0 . Silt❑ Clay ❑ Peat❑ Sandy Lo m 0 Clay loans� V Hardpan (j Adobe [] Fill Material ............ If yes,type.._......_._ ` ........... ------- (Plot plan, showing.size of lot, location of. system in relation to wells, buildings, etc. must be placed n reverse .side.) NEW INSTALLATION. (No septic tank or seepage pit permitted if public sewer is availajle_within 200 feet,) PACKAGE TREATMENTSEPTIC TANK +. e v "r [ � f a 5iae...�`'r..'�_�y�x.�------- ------------ =liquid Depth • �.�... Capacity .. �-�.�?--i.. Type _.G Material....................... No. #Compartme is ..`%............. F �'!f ry �. Foundation-_... a Prop. Line ............. Distance to nearest. Well ....... ...................: ______ LEACHING LINE [ ] No. of Lines ..._.. `. _0 . . Total Length ' " ............ LengthVof each line" ._-_-• D' Box II Type Filter Material i4. �rbepth Filter,Material .._..� ��. ......................... . Distance to nearest,l Well........�,?�0........... Foundation .......1.Q_........... Property-Line.°..../Q._ SEEPAGE PIT Depth i� ••-•-.._. [ ] p °r�i.,�_�..._ Diameter .... ��... Number 3.....__.f.1,Rock Filled 'Yes.a No p Water Table Depth s.................................Rock Size --...• ......... ---•- Well ' Distance to nearest: ......1.�?..4?......................Foundation .�'�?_.._-_._. Pro Line ...lp__.. 1 - REPAIR/ADDITION(Prev. Sanitation Permit# ..........._._.--••--•...................... Date ____....................... I Septic Tank (Specify Requirements) .......................................................................................... ._... Disposal Field (Specify Requirements).................................--...... ... ....... r .......................... - ..........................------------------------------------------- (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 which this permit Is issued, 1 shall not employ any person in such manner as to '' become subje to W rkman's ompensation laws of California." Signed ....... r. . . ' - ............................................ Owner By ............ ................................::.............•=......._..---•----•---............ litle ..........................................__....._....: :... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. - .........-•-•-•------------ ............................... DATE _. -.�'.' ................... BUILDING PERMIT ISSUED 1 ...................DATE ADDITIONAL COMMENTS k-7. . 7.. ................................... .......... .----._.__._....................................... ., ............ ...._..•............................ ........................................... .... . ................ . ............•----*............ . . . �.. .... ....................I..................•----FinalInspection by: ...................... SAN JOAQUIN.LOCAL -HEALTH DISTRICT E. H.13 24 I.-.&A j?.. _q ":V2 �.7:-T n � � F