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2 FOP_OFFICE USE. APPLICATION FOR' SANITATION PERMIT F F (Complete in Triplicate) Permit No. .�. ............. / ..... This Permit Expires 1 Year From Date Issued Date Issued _.......~........ . 0.5'r — 700 ---too 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 istinng Rules and Regulations: JOB ADDRESS/LOCATION � --�� '�` � t/ ]+�� '! S'-� 1 ... lte re�,td►v�.CI NSUs TRACT Aq-,7........... 7. Owner's Name ...... rr5 Uis(c' ---•-------------------------------------------•- -----....-......_.....-----..Phone3!� ;;518.�............ Address �..__..�.P''....................................... ....... City `. Contractor's Name s _.......------------------------License #as'SF-; 3...----- Phone 5��-_` 6 aT..._.. ; Installation will serve: Residence (Apartment House❑ Commercial []Trailer Court 0 Motel ❑Other ----- Number of living units:...._._... Number of bedrooms -&......_Garbage Grinder .. _.. . Lot Size Water Supply: Public System and name .......................................................... ..........Private Character of soil to a depth of 3 feet: Sand 0 Silt[J Clay ❑ Peat❑ Sandy Loam Q Clay loam 0 Hardpan � Adobe E] Fill Material ...... ----- If yes, type ........--.-.. . .._ . (!1 (Plot plan, showing size of lot, location of system inrrelation to wells, buildings, etc. must be placed .on reverse side.) O NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , PACKAGE TREATMENT j ] SEPTIC TANK Size..-...1a4?_. Liquid Depth ._.d `�'��_. _ . ._. .. . .... Capacity Type -------[_p R. Material... No. Compartments O�-_-_--......... � Distance to nearest: Well ...fir?'..... ............. ....:Foundation ...6: ....... Prop. Line . .�'`._....... LEACHING LINE No. of Lines y _. ...-_ Length of each line ..'.. ............... Total Length ./q?�qkm ............. 'D' Box .: _._ . Type:Filter Mciterial- e(, F Filter Material _-l$-._`.__...._ Distance to. nearest:.::Well:.--:�---- ` Foundation- 4?: t T oe' ., ' .,= .. Property Line _94`./7..... SEEPAGE PIT Depth _cava-....... Diameter 33------- Number .._... ---- Rock Filled Yes J No Water"Table. Depth --•---7 ?...............................Rock Size W Distance to nearest: Well .......66--a'-----....................Foundation .._._.._.-_ Prop. Line _.__7S_.......... q. REPAIR/ADDITION(Prey. Sanitation Permit* _._......................................... Date ----------------------._.._-------i Septic Tank (Specify Regvirements)......_.,..._............... ....................... ................ ----------- ........................-...------•--• --....... Disposal Field (Specify Requirements) ---_------•--•- ---•-------_----_---- .---- _------------__----------------- . _.. ------'............................................................ ..........-----------*..-----.._..----- (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 Regulations of the San Joaquin Local Health District, Home owner of 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 .:._ :.... .. Owner ........... -- -• -- _--- By ...: _ ... ........... .... Title -�r _ :............. .........._.. (If other than owner] ` FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY . . _.. ............ _:.._.-.. ..... DATE .��Z.�......` ,.. ._.:'.:.. BUILDING PERMIT ISSUED ...............................-... ....._.__.........DATEr, ....:.>:: :.._..... .. ADDITIONAL COMMENTS ------ ............ • --------------------•-•--...---•--�------..._.....----------..-..,_.....:.:__.,:_.:....:.:._.:.._..,..._..._.._..------• r ................................. ._...._ ---------- ------------------------------ ----- -----------------------•--------...............-.---. ------------------------ Final Inspection by: ..- ---------- -----.:-------.....•-•---....._......... --.......Date% -------------- SAN-JOAQUIN LOCAL HEALTH DISTRICT E. H.L3 24 1-'68 Rev. 5M 7/72 3 m