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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. i Permit No. ...__...... f 1, (Complete In Triplicate) .......... N - This Permit Expires I Year From Date Issued Date issued ..�'.' ..7 .................................... ff � plication is hereby made to the San Joaquin Local Health District fora permit to constr Apuct and Iiis ail th'e work herein `described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulafions: ;JOB ADDRESS/LOCATION ,._V a.1-1j, , ._,Lk!�....., .................... CENSUS TRACT ...... .................. Owner's Name ... --------.....................................Phone . . .. ._.. .._. _,. -- •-•-•---- �Address ._.. '/7 .._... ..... ----------------•---•---------....... City _ _.._..._.................._.......I....... ....... Contractor's Name .../-174r -=119_ClA�`------............:.................License #A' 4 �� Phone Q?-"K- flnstallation will serve: Residence g Apartment House o Commercial `[]Trailer Court 0 Motel ❑Other .........--- r-h-------------------- ------ Number of living units.--/----- Number of bedrooms _._...Garbage Grinder /1/e__ Lot Size o& e�ocue `Water Supply: PublicSystem and name ......................................: .......................................................................Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fl 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 if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK.[ ] Size...-........R= -------------------------------- Liquid Depth .........___........... ... k Capacity ......... Type................ Material------------ ... No. Compartments ............, Distonce to nearest: Well ....................................Foundation ...... .............. Prop. Line ................. E.EACHING LINE [ ]' No. of lines ------------------------ Length of each line------- Total Length _._.._._.....___............ ;D' Box ...... Type Filter Material --------------------Depth Filter Material '----------.............................. Distance to nearest: Well.......................... Foundation _.._ ................... Property Line ...__-.................. SEEPAGE PIT E j Depth ....... ............ Diameter ------;......... Number ..._•....................... Rock Filled Yes ❑ No ❑, • Water•Table Depth i ..................._.Rock Size -------------------------- - --- � Distance to nearest: Well "`..:'.................................Foundation .....__............. Prop. Line ....................;PF REPAIR/ADDITION(Prev. Sanitation Permit# ' - -------.._..__._.......................•---...Date ----------.._----------........... ) Septic Tank (Specify Requirements) ,. ............ ......... •............---..........- —...------------------------ _ Disposal Field (Specify Requirements) - '- ..�- _.Es � ��1-------•-f'�_ _ .ir _._. rG. I ..... ............ _ . ._... ------------------------------------ I - --------------...---------..........------------------ I (Draw existing and required addition on reverse side) 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: k f ;'l certify that,in..the performance of the work for which this permit is issued, I shall not employ any person in such manner F s to become-sul6lect to-Workman's Compensation laws-of California." "' t signed ..., t • Ow;ner CBY ---._.... ! ';.......... .. ....�. _.._,.:_.. Title1 �' lel` ........:............................. other than owner) PARTMENT USt ONLY PPLiCATION ACCEPTED BY ...... ..------•------•.........:............................. DATE ... ...... ------ !BUILDING PERMIT ISSUED .... - ATE ................. ADDITIONAL COMMENTS --•.............. .• ...... ..... .. ••.-••••..... -- -- ------ .................... '` ---- --- •- . -a:. . .-••--•------•..._.... ...__•............ ............. ._. ..-'_..__ ._ ........._......._.. ............. .d.......... _____ --_ __-- •._ .---------._.............................._®: ............................-------- .. .... ... ...... Final,inspection by: ....:' ........ •- .........-................................._.._..._,...... ------.Date.-.: .: = �y�............ N J QUIN -LOCAL HEALTH DISTRICT E H-13 24 1. 68 Rev/ M . 7/72 3 M _j