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` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7_Z....3.ZjD This Permil Expires 1 Year From Date Issued Date Issued .Y.4'_77-Z Application is hereby made to the San Joaquin Local Health District for a permit to construcT and install the work herein F described. This application is made in compliance with County Ordinance N 549 and existing Rules and Regulations: JOB ADDRESS/LOCA I�_--��__ /F-. �fTG -( .- ............. ---.....CENSiJS TRACT -------------------------- iOwner's Name ---- - - -------------- -------------------------------- ---------------- :---- Phone................. ..-------------- ° Address F �Cll ------------- City -------------------------------------------------- Contractor's Name c / y License#� d.3d...._. Phone .................. Installation will serve: Residence Apartment House C] Commercial]]Trailer Court 0 Motel©Other------ Number of living units:..._ Number of bedrooms 3_____Garbage Grinder ------------ Lot Size _-_ :- - -------- Water -----_Water Supply: Public System and name--------------------- --------------------------Private I Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay © Peat❑ Sandy Loam i] Clay Loam € Hardpan�( Adobe❑ Fill Material-------------If yes,type--------------_-_---__- F' (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 I j Size---------------------------------------------... Liquid Depth .........._.............. Q Capacity ----- ----------- Type .............. Material---------------..... No. Compartments \ Distance to nearest: Well ------------------------------------Foundation---------.------------ Prop.Line---------------------- LEACHING ---LEACHING LINE [ j No. of Lines ............... Length of each line........................... Total Length ..._..--_.,_.__....--...--_ 1 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ---------------------------------------.--•- Distance to nearest; Well ----------------- Foundation __.___........--- j;- Property Line ------------------------ SEEPAGE ---- SEEPAGE PITRepth -------------------_ Diameter Number .. Rock Filled Yes © No❑ [ j _ Water Table Depth -----------------------------------------------Rock Size-------------------------------- Distance to nearest:Well ----------------------------------------Foundation .................. Prop. Line -...__.----------._.. REPAIR/ADDITION(Prey. Sanitation Permit#-------------------------------------------- Date _____-----_------_-_.--------_____) Septic Tank (Specify Requirements] -------------- -— -................ Y -------- Disposal Field (Specify Requirements) ..-- 1 -------------- 11& -----------------------------------------------r --------------------I---....--- --........ ------------------------------------------- ----....-- -------------- ------ (Draw existing and required addition on reverse side) t hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following- .P "I certify t'hat in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become sublect to Workma Lmpensa fion laws f California." t !` Signed ------------------ . i • fJ F Owner C ��f By - -----C/ -i . . .....Title.��-�/ u_v c'c (If other than o ) ............................. ---- ti FOR .DEPARTMENT USE ONLY I M l7-z. APPLICATION ACCEPTED BY_..... �-� .......................- ---------------------------- DATE - ---......- - ----------- BUILDING PERMIT ISSUED ------------------ ----------- ------------ ............DATE ------------------ ADDITIONAL COMMENTS----------------------------------- - ---------------------------- - ---- - ----- ------------------------------------- - Final-1nspection by; A.-..ri 2-:= G' -- ------------------------------------- -----------------------------Date : . ..... c SAN JOAQUIN LOCAL HEALTH DISTRICT ' 9 H E.H. 1-68 Rev, 5M Ii - e