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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT ......................................................: (Complete In Triplicate) Permit No. .. ...................................I............. This Permit Expires 1 Year From Date Issued Date issued .. :11A Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heath described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: / JOB ADDRESS/LOCATI ..........S7. •_.. ,/�y��G f CENSUS TRACT Owner's Name .. . Cl/ ltP��.cPr...... .. . .....�0--••�/ft. ........................ Phone ............................... Address ................................. �/�0.4. .........- city . .. . ,�r�,rs y...,r .tr. . cl ►!?.....I.................. .. Contractor's Name -..... /Z. .........................._...........License # a71 T Phone installation will serve: Residence partment Houses] Commercial 07raller Court ❑ = Motel[]Other............... ............................ a-49>1 r Number of living units:....../.... Number of bedrooms„....Garbage Grinder - -C3$.. Lot Size ....1 a- ....... Water Supply: Public System and name ...........................»..»._...................._....... .........................................Private _ Character of soil to o depth of 3 feet: Sand D Silt[] Clay (] Peat Sondy Loam o Clay Loam j] Hardpan j] Adobe Muterlal�.. 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.............................-.--n—........... liquid Depth ......................... Capacity -------------------- Type .................... material...................... No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. Line...................... LEACHING 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 ( 1 Depth .................... Diameter ................ Number ............................ Rods Filled Yes l] No Water Table Depth ................................................Rack Site ................................ Distance to nearest: Well .......................................Foundation .................... Plop. Une ........-............. REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date .................................i G Septic Tank (Specify Requirements) ...................------------�... ....................--••--....-.....__..........A........_... ------.- Disposal Field (Specify Requirements) .........�/ci f *........ .. ! .rr.: e.....� . ....... ........................................................................................................................_...... .............................................. ...................... ............_._.........................--•--..... ----------I--------I..._.................................._........................................................ [Draw existing and required addition on reverse side) I hereby certify 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 ownor 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 .... ... ........ . ... ....../.�.�. /..... ................. ........................... Ownerl� By - ._... .. .-1 ...AY��............. ................... . -- Title .. . .. � . '1......-......................... (If r than owner) FOR DEPARTMENT U NL APPLICATION ACCEPTED BY .. ............. ..............._ - - .... DATE ..0�.1.7.L6.... ..............: BUILDING PERMIT ISSUED ---------........................................ ... ........... - ........---DATE ............... ......................... ADDITIONAL COMMENTS ---------------- .7...1................................-............:.....................................................:........................... .................. .......... . :......... ............................................:............................................ ....................... ..-_......................................................................................................................................................-............................................. -----•-----------•.................................. ..... ....... •........... ...................... . ...... .. . . .. r Final Inspection by: ........................................•---•--.............. ...................:..........:.......... .. . . . ........Date ... ..-i.7..' .r'-....................---�- Elf 13 2h 1-68 Rev. 5m SAN JOAQUIN LOCAL FIEAtTH DISTRICT 8/7h 3M rX