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yy,. FG�LOFFICE USE: `` APPLICATION FOR SANITATION PERMIT _ ............. ..................I.._. (Complete in Triplicate) Permit_ No. --•,•,•... ' • ' Y ,.- ..................................................... t � • This PerEmit expires 1 eDote Issued ---.�-.:-,, _.- ar From Date Issued : Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins' the work herein described. This application ismadein compliance with County Ordinance Na. 549 and existing Rules'and Regulations: JOB ADDRESS/LOCATION//..Q{.p/�J eR ltQ� ..lid.'..............................I...........,..................CENSUS TRA �.r..i Owner's Name �.1. .....ual;4F, �ai�............................................:.�..................Phone_.. C ..... Address ..... .'-:.---•----........................................................City .�'fu ........-:. Contractor's Name ....... �4ly.........................:-------.License #,?7KrSl._- Phone l..I Installation W,111 serve: Residence ApHouse C] Commercial❑Trailer Court 0 / `' artment Motel Other ................. Number of living units:.--.C...-..'Number of•bedrooms JV........Garbage Grinder Lot Size .....__---..-.-. 7. Water Supply: Public System and name,.-!.......................s............................_.........................................n= ----------Privateliff Character of soil to a depth of 3 feeh Sadd p `SIIt❑{ Clay ❑ Peat)] 5andy loam}] ' •Cloy Loam 0 A� Hardpan.❑ Adobe)4 Fill Material ...........- If yes,type:_-_�..-..tc_.-- V L (Plot plan, showing size ofAot, location of. sys4M-In' relation to wells, buildings, etc, must be'blaced on reverse side.) O NEW INSTALLATION: (No septic topk or seepage pit permitted If public sewer Is availablewithin,200 feet,) PACKAGE TREATMENT j ) SEPTIC TANK( j Size...............n,:............................ Liquid Depth ......................... Capacity -------------------- Type .................... Material------................ No. Compartments �.�—. Distance-to-nearest,-Well._.=...................... ....Foundation .......,--_•___......`Prop..line_..................._.. LEACHING LINE [ j No. of Lines ........................ Length of each line.......:".+.................. Total Length ............................ 'D' Box ............ Type falter Material ....................Depth"Filter Material ............................_.............. Distance to nearesth Well ........................ Foundation ..^.................... Property Line ---............. ....... : SEEPAGE PIT ( j Depth .................... Diameter _........._.. Number,:..--. ...........-_-_:_:.. Rock Filled Yes ❑ No Q � Water Table.Depth,......._......_............... ____:---•__..Rock Size ................................ Distance to nearest: Well .......................................Foundation w................. Prop. Line ........._........... REPAIR/ADDITION(Prov. Sanitation Permit# . . ._... .........=.................-Date .. ......... _\............ 1 . Septic Tank (Specify Requirements) ...4 -,t _ -- 1--=1 !.�..1� ll�t.74fA -.l: AXWO.W.W Disposal Feld (Specify Requirements) .................................................. �_......'.-...__....--•---..........-®t, ...-.............................. ................................................... _ ..........___....__...._.. ._`...._..........._............ ........-.................................._ ....._.._...._...------ I- .:..q.. ................2e... :... ::............................ ..... ----- - - .,,.... Draw existingand required addition on reverse sid ).\ rI ,.146 ._^y i I 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 ownef or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is issued,.I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................... ..... ............... ... Owner By ...........:........ `------•........----------......... Title . ;* .. 0`1~ (1 ei than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... . ... -- --...---................................. ............ ........ DATE ...... ...,/ ._ . ...-.....-..... BUILDING PERMIT ISSUED......---- --- _..... ......._.......................................DATE .......-...... -,........-... _.. ADDITIONALCOMMENTS ..................................................................___.._........................_...._......--.....----,-..._............-........._.._._...._ ........----...........................:..... . ... .. ... - Final Inspection b_y: ....:....- ...................................................Date ............ ..{� .?. ............_ SAN JOAQUIN LOCM HEALTH DISTRICT WV` E.H.3-3 241=68 Rev. SM 7/72 3 M