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FOR OFFICE USE: gpPLICATION FOR SANITATION PEr 'IT _.. .... - - - ._...- PermifNo. .7L:. t,J (Complete in Triplicate) - -- ... . ... ---- --- - L _, This Permit Expires 1 Year From Date Issued 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/LOCATION ---- -_ _ .. . - ENSUS TRACT .__-...-.._-_....--.-. ... Owner's Name �2�!°------------- ---- ------ -- — - � _-�------- --- Phone ---- --_ ------- City . -----------------------_._...-....... Address ----..1__ _sZ... ------------f - -- ---` > yvf1--- +. Contractor's Name --- --....C._.> ilr-GF.�.>------,( "/�" ---....-_-License #c .4�:-7,47..'y.- Phone Installation will serve: ResidenceAApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other Number of livingunits:__ --_-.. Number of bedrooms _ _ Lot Size _ -__�� /� _.�y-,--Garbage Grinder It/ell- - --_-------------- Water Supply: Public System and name ------ -- -:-G- - . CsJ--e .-.._-----------_._ -------------------------Private Or Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Or 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,) U PACKAGE TREATMENT [ ] SEPTIC TANK f ]E,C t-T7-1:rSfie-- - -- ------ ---- - - - - - Liquid Depth Capacity -------------------- Type --------------- Material------------------ No. Compartments ----------........ Distance to nearest: Well ---------------------------------Foundation --- Prop. Line ---------------------- LEACHING LINE No. of Lines Length of each I'ne__ P g �� - Total LengGth '".�U"" ""-". - 'D' Box ..../__ Type Filter Material __l/: ----Depth Filter Material ---1I - --- -----------------'---- Distance to aneeaarreest: Well --.s �__---_- Foundation _.L4:- --------- Property Line _- SEEPAGE PIT Depth .OW-4 --- -- Diameter _ _ Number ..__ ......._.__._ Rock Filled Yes No i❑ IK Water Table Depth ---------�PJ ------...-------..._-Rock Size --- ------------- r � Distance to nearest: Well -.-_.-/_O_G_-.-. -------- ...Foundation --- Prop. Line ..- ---.---- REPAIR/ADDITION(Prev. Sanitation Permit# -------------__..___ ------_-._...... Date ---------------------------------) Septic Tank (Specify Requirements) / - ------ _------ -- ----------- __ ----------__--_.--.-- 17 - G-z- " . / / ---_------- Disposal Field (Specify Requirements) ---- - _.-.. ------._..-------------------..------------------ (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _._----------- -- ------------------- -- ------. Owner By ....-- . C��.�t t - iC_-_-:-------.._ - Title (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- -- - -- - -- - -- - ----------------_-.----------.__-...---------- -- DATE BUILDING PERMIT ISSUED .-- - - _... - ............DATE ..... ----------------------------------- ADDITIONAL=dl=1 - T - -- ------- - - . - _COM 1 - - - -- ---------------------- -- - - - -- .. .-_.... -- . --- - - ---------- - --- ------- ----- ----- - -- - - --- -- - ------- ------------ -------- -- - �----- ----- ----- --------------- 7Final Inspection by: --- - - - ----- - ---- -------- - ------- - . ..._ -------- ... -- SAN XQUIN LOCAL HEALTH DISTRICT %1 E. H. 9 1-'66 Rev. SM