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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No. _ ( (Complete in Triplicate) b - Date issued _.____ _�---.--- This Permit Expires 1 Year From Date Issued j 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 with County Ordinance No. 549 and existing Rules and Regulations: ` 72 '4- 0702- ........... NiV1 --- ---JOB ADDRESS/LOCATIOlAf5 — A __ _ Owner's Name __s�t� rf1JYG'1S _ �L ----------------------•-------------------Phonell Address 40 rho /� /_N/�__ City _5/ s f� . / _ _d. Contractor's Name .....-----��---�-�-��-------------License #d2W17-3_-- Phone -�-----...-----.� Installation will serve: Residence ❑ Apartment House,[] Commercial :❑Trailer Court i❑ Motel Number of living units:_______ Number,of bedrooms __ ___--Garbage Grinder .--------- Lot Size ------------------------.---------- i Water Supply: Public System and name ------------------------ ------------------------------- Private . Character of soil to a depth of 3 feet: Sand'❑ Silt❑ !Clay ❑ Peat Sandy Loam 0 Clay ;❑Loam W Hardpan ❑ Adobe '❑ Fill Material ------------ If yes,type ---------------------------- I (Plot pian, 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,} y / PACKAGE TREATMENT [ ] SEPTIC TANK SSiiize_e_7_!�---------- Liquid Depth _____________._--____---__ Capacity/ 1Z D_____-_ Typeev+��` '�!Material_��__��_------ No. Compartments -.___�------ r / Foundation lJ /�l��I/_-- Prop. Line _ _ Distance to nearest: Well la___________ ___________ ` ` < LEACHING LINE No. of Lines ____ .__________.__ Length of each line___ O-.______-______ Total Length /40-X17LL --------- A, � D' Box --- ---------------- ' / _ Type Filter Material t_�CJ_C,�_Depth Filter Material _____�_ __ f Distance to nearest: Well � ---------____t___-- Foundation�0_/y -W----- Property Line � .- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number --------------------------- Rock Filled Yes ❑ No Water Table Depth --------------------------------------- --------Rock Size -------------------------- Distance to nearest: Well ----------------------------------------Foundation --------------------.Prop. Line --------_._.--- A REPAIR/ADDITION(Prev. Sanitation Permit t# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------- -------------- ---------------------------•------ :-------------.__" `_"_�__---- Disposal Field (Specify Requirements) _, �% Y ------e_ -----�------ �-C-� I t � 4 ----- ----- - ---- -------------------------------- ---- ---- ------- ----------------------------------------------------------------------------------- ------------- (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 be a subject to orkman's Compensation laws of California." i Signed --- ---J-E'``-_ ------ 5-------------- Owner -- Title -------- --- -------------------- ------------------ -------- BY ------- ---- ------------------ - - - ----------------------=----- - (If other han owner} R .DEPART ENT USE ONLY APPLICATION ACCEPTED BY --- -------- -----------. DATE ---w-_'- - -- ------------- ----- -------------------------------- --------------------------------- BUILDINGPERMIT ISSUED ------.--- ------ - --------------------------- ----------------------------DATE ------------------------------- ----------- ADDITIONALCOMMENTS ------ --------- -- - ------- -------------------------------------------------------------- ------------- -------------------------------------- ------ --------------- ---------------------------------------------------------------------------------------------------- ------------ -------------------------------------------------------------------- -------------- Final Inspection by / -------------------Date ------l �r-' - ------ SAN J QUIN LOCAL HEALTH DISTRICT + E. H. 9 1-'68 Rev. 5M.