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FOR OFFICE... USE- ...... SE: ........... .............................•---...- APPLICATION FOR SANITATION PERMIT 7�-.��7 (Complete in Triplicate) Permit No. . ........................... This Permit Expires I 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 in compliance ith County Qj3dinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ..... 4S .. -.. ...... . .......................CENSUS TRACT .......................... Owner's Name ........ .. .... .. .......... .. •--- •..... ......................... Phone Address '7 .....� ... ,..--- .......................... City ......................................... Contractor's Name .... : t-PA.r.`�� - -. .. 'cense # cXV--P,_P.,7--. Phone . r . Installation will serve: Residence; °Apartment House C] Commercial ❑Trailer Court Motel ❑ Other ............................................ . Number of living units:-.- .-- Number of bedrooms -.�-----Garbage Grinder � Lot Size ._L_y�j_�� r Water Supply: Public System and name .-.-.._. 'G �-�c --•---.._[Ei/ .....•-•--•....--.•.....................: -.._..,.Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe A Fill M6terial .....--....- 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 p)t permiffet� If public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK[ Z`/I_/S TSize.... ................. ........... .......... Liquid Depth .........................- Capacity .................... Type ............._._.... Material...........•.......... No. Compartments .....................- lw Distance to nearest: Well ------------------------- ....._._...Foundation ...................... Prop. line ...................... N LEACHING LINE � No. of Lines --- g � Total Length Len th of each line...-.. .-_f ..._..... r-. .Ct................. 'D' Box .. Type Filter Material ,o..� .....Depth Filter Material ._ ,r!....................... ......... 111 Distance to nearest: Well . .fE Foundation ..,F--—C_.�...-------- Property Line .......--------- -- SEEPAGE PIT Depth V21f.-_... DiameterNumber .../..-----.. Rock Filled Yes I:v No ifl Water Table Depth p ...............Rock Size c Distance to nearest: Well .. :..1. I ..........Foundation ..... Prop. Line (1D REPAIR/ADDITION(Prev. Sanitation Permit# ....................------•................. Date .................................. Septic Tank (Specify Requirements) --------------------- ... ......•--•--- ------------------- -•-- ...................... r r 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, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ....-.. O � wner By ..-----... .. -----...- .--.. xitle ... 2 (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... ,� ----------------------------- DATE .---�7 2,.2.72... BUILDINGPERMIT ISSUED .........-•---•---•-- -•............................•----------------- --=-----_---.__DATE ----------............................ •. ADDITIONAL COMMENTS ....................................................... .......................... ...... . .....- ..................................... ....... ....... -- .........4_.....................--.-...............•.........•.......................................................... - - ------- ----- t .------•-- Final Inspection by: ....... .... . �. .... _ ...._..----- ._._......Date ....^... SAN JOAQUI LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M