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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ --- 1Complete in Triplicate} Permit No. .7� ................................ ................ 7.� ...... This Permit Expires 1 Year From Date Issued Date Issued ..1..:...."... Application is hereby.mode 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 C'o`unfiy Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... 1`7• r (N.-------`Z...... ../-2i................ ...... ..... CENSUS TRACT ....._...------...----. Ow ... ner's NameT _M.-: - r .__� ._......_ ..-_-_ ~Phone ...:-_w. �-- -- Add City - Contractor's Name c r.. license # .G�' �' �' Phone`------ •. ................ s Installation will serve:: -Residence Apartment House fD-Commercial M []Trailer Court Motel {] Other•...:...:...:.. . Number of living units:.; ,.._ , ..Nu.mber of bedrooms.. ..._.G'arbage Grinder.:.......... Lot Size _.._.___.._._______:.._.. _.-- '.._.__.1.. _ .. z. -�;--- t Water Supply: Public System and name ................. - _----- ----Private Character of soil to a depth of 3 feet: Sand ❑ Silt E] Clay; ❑': Peat[] Sandy. Loam'0 Clay Loam Hardpan ❑ Adobe El Fill Material . If;yeso type -- ....... --------•---_--. {Plot plan, showing size.of.In't,-location .of system in.'relation'.ta .wells, bu:ildiri s etc.:.must be .placed on,reverse side€} j I4EW INSTALLATION: (No septic"tank or seepage:pit permitted if.'' ublic sewer is available'within 204 feet,):. = PACKAGE TREATMENTSEPTI --Size[ ] C TANK [ ] Size ........ _ + - . ...... Liquid Depth _ _. :. Capacity Type :.... Material_,; :No. Compartments i r ... - Distance to nearest. Well i _Found I Foundation Prop i � tjo Line -- LEACHING LINE [ ] No. of Lines Length Of!each line Total Length .__ ' .................. ' Type terial Dep`th'.Filter•Material D' Box T e Fi!#er Nici t Distance'to nearesf:-Well ......:�_: i Foundation .. = :. Property Line .- ... _ F SEEPAGE PIT [ ) ; Depth , _ Diameter _:__ -Number :_..._ ' Rock Filled . Yes 0 No IE] . -- ----• _ I Water ,Table Depth:_ Size Distance to;•nearest Well - _ .Foundation:..::.. .....: ..... Prop Line . REPAIR/ADDITION(Prev. Sanitation'.Permit# ...__._._.. ............:' - .._,Date ....................... _._ } Se tic Tank Specify Requirement ) )Disposal Field (Specify Requirements) ..................... `7tlr�a � ..-........--. ......... ...-....� _, - -� ._ _ .._ .. ---------- ---------- -------- .... I ---------- - ----------- -------- ------ ... ........_._............... .._....., (Drdw 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..Regulotions of the Sari Joaquin Local Health;District. Home owner or Ilcen- sed agents signature certifies the following: "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 subject to Workman': Compensation laws 'of California." Signed ..........ned ---------- •..,-._...--- .. _ Owner' _. y - . .✓S�_�` `` tie (if other than owner) R . PARTMENT USE ONLY APPLICATION ACCEPTED BY .. ;: ; ........_._ _._........ DATE !d ... ....__...._. BUILDING PERMIT ISSUED .................... .... .:.......... ..................... --------...__.. ..- -------- DATE .............. ADDITIONAL COMMENTS ...... ........ ._..-----• _ ----------------- - . -- . - -- _... ------- --- -- -- -. ------- .:. - -- -- ..... .--------- ........ •---- .. ... •--_.. -- ---- .._..... Finaf'lnspection by. bated $ ............... SAN JOAQUIN LOCAL ,HEALTH DISTRICT E. H. 13 241-'68 Rev. 5M 7/72 3 14 J