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FOR OFFICE USE: - APPLICATION FOR SANITATION P T ._ . i ( t- --�._.. . ..- .__.._. (Complete,in TripRmb) OW EL/mit No. �.. This Penn"t ExPims t Year From Dab Issued Dare Issued _.2--/... -.73 4 '\ 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: JOB ADDRESS/LOCATIO _e... ...Tp. . .,'21, -- Owner's Name - -- z+-Ql-.._._.. -.CENSUS TRACT SN...7 .. -_ �---- -...._...-___ .. . - __ .-..Address _ _ . Phone - ✓!' G ---- •- - - City . . ... ---- - - ........... Contractor's Nome _--- _-License # pp ' f�ff82'Phone .._ . ---..--.---.. Installation will serve: Residence Apartment House ommercial Trailer Court Motel ❑Other -_ � Number of living units�.r--r. Number of bedrooms ___ ;—Garbage rinder _-_.-._.. Lot Size - -- - ._._-. .._ Water Supply: Public System and name .-..._.....___. _ . . . -.Private - Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [e Clay Loam ❑ Hardpan❑ Adobe ❑ fill Material if yes, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) V) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewers available within 200 feet,) LA PACKAGE TREATMENT [ ] SEPTIC TANK $ize../-- ,'/, ._.. q ' d .r .--L-.---x.-- ----- Liquid Depth C/................ N Capacity -1.Z-e 6-, TYp -- Material- ..... -_ / /C Q _. No Compartments 11Pa. .--.------- Distance to nearest: Well ...__ J}.- __. .. ..... Foundation _. _-��._ -.... Prop. Line . ......... +I LEACHING LINE No. of Lines �.._, - Length of each line q.b _ Total Length ._..-_ ..�._......-... rJ 'D' Box ...--_ Type Filter Material ...R_-Depth Filter Material .........�-,�. " i Distance tonearest:nearest: Well __... ._�..._..... Foundation .....L..a..�__. Property Line :.--. ^_ SEEPAGE PIT [ Depth - CP S.�.. Diameter[_�_ �..t Number __._� ...._.. Rock Filed Yes �T No [ Water Table Depth .._.._..._._.-i-p.._..._---_-._--._Rock Size ....L.��a..._,rr.-3..._- 'l Distance to nearest: Well _ .I:l.p --------_-_Foundationf A..h._........ Prop. Line ---...- -------•- REPAIR/ADDITION(Prev. Sanitation Permit# _--- ____.-____-... .... ._.. Date ........ Septic Tank (Specify Requirements) ---..... ..------...._.._..-----....._._.._.....-.--- ..----.-_- Disposal Field (Specify Requirements) --------------------- ---........ ..._ _ __............. . .. ... .....-_...---.-..... ___.....-.__.__...----.. ...... -.... ... .. __. . ..... .___-.._...----._..-......... ------------ (Draw ( aw existing and required addition on reverse side) I hereby cerfUy that 1 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 autifies the following: 'N certify that in the perfomrance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed Owner By - _.` . . -. a... Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----Pcrr:<rc• -t°:=`-------.-------.,-_---_---.-.._.-_..._..__.-._. DATE eZ.-'�. -J-' -------------. BUILDING PERMIT ISSUED -'----.-_.....-... _...___.._----__---___.............._ __...........----_..._.DATE -.. _---..._.._... ADDITIONAL COMMENTS .. ..._. ._ ------------ - __...._...._____. _...._. . ---------...__....................... � .... -.. .. .. .. ... . . . .. ----- 11 _- . ... .... . Final Inspection by. . Date _ _ - nP�. .7 - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M