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FOR OFFICE USE: 4 ............................................... APPLICATION FOR SANITATION PERMIT J l73 lComplete in Triplicate) Permit No. .... ................ 3761 This Permit Expires 1 Year From Date Issued Date Issued .. ._1 - 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 jmade incompliance /with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC ION ..........CENSUS TRACT .......................... Owner's Name -....... ... - ----------------- -----------•-•-----------7.......... ....................Phone ............................. Address ....... 1. .9 -. !.q. G� s .�..... City _. ��ha�e-h. .. -I��'_+.................... Contractor's Name ._.._._ .��''•._ 2tt ' . .i �e�-----•---••-- -----------------License #ctM!'71 Phone 4451474 .-- Installation will serve: Residence ❑ Apartment House❑ Commercial ®Trailer Court ❑ Motel ❑Other,5�a Number of living units:.. ......... Number of bedrooms ------------- Garboge Ga ri nder .._ ........ Lot Size .... ................ Water Supply: Public System and name ..................------.-------------------------------------- ........................Private 10 I Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam X3 Clay Loam 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 ,) �1if public sewer is available within 200 feet PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size..-3`/ -_ _ . ................. Liquid Depth a................. Capacity/afwx-Iq.. ...... Typ C<- � Material, .• `... No. Compartments .. —...........j-0, Distance to nearest: Well ................Foundation .P2-247_........... Prop. Line ./ ......... LEACHING LINE [ ] No. of Lines Length of each line ........ Total Length _.f'v............. 'D' Box ... Type Filter Material 1 � -----Depth Filter Material -le..................................� Distance to nearest: Well �_--- �-.-_._...... Property Line.... i s _--- -_-_-._ Foundation .-- ............ SEEPAGE PIT [ ] Depth a �__.__... Diameter s ------- Number ...-..2................. stock Filled Yes (g--�No 1 Water Table Depth _..-.- -'�- --- Distance to nearest: Well _. ..�Q.__.._--------------------•---Rock Size/.21. #. -- ............. f p �'................f f � —Foundation `��... _-._. Pro Line ...___. ... _ REPAIR/ADDITION(Prev. Sanitation Permit�# ------------------------- ------• -.--.. -- Date ---------------------._.--......--1 rSeptic Tank )Specify Requirements) ....... .... Disposal Field (Specify Requirements) .... �. ------------................ ----- -- ---- ------------------------------• ...-•---...--- ----.. - ............ ........................ ------------------ � ..�...__...._..._.........---..._......--......._....-- ........ 6 ---- -------- ----- ---- ----------- - .r ----- 2e lDra'w 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 Ord noncesSta.teL.aws, and Rules and.Regulations .o.f-4he San J aguin Local Health District. Home owner or liceth 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's Compensation laws of California." Signed _:.... - - .- .. .... ....... .... .. ................................ Owner ti R - ... Title ............................... By If p her tha owner) FOR DEPARTMENT USE ONLYi APPLICATION ACCEPTED BY .,. __J �.4�.- �!. .- ,..` DATE :7,3 BUILDING PERMIT ISSUED ........ .......... ....•....,. .------.....--- -- ......... ....-t---.....DATE . ... ............................. ADDITIONAL CO 11MENTS 4 r 1� -- } - - ----- ----•-- ---- _ _t_.. .... -_........ l ---�=----- •-•- ------------------------------------- ----------- ...-•--•-- ------ ------ ------------ --- -• ---- . ................. ................ _ ......Date Inspection by: tiN .. _ SJOAQUIN LOCAL HEALTH DISTRICTY 3 E. H.13 24 1-'68 Rev. 5M 7/72 3 .K