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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ICompiete In Triplicate) No. ,7� 3... ............ ............................................ This Permit Expires 1 year From Date Issued Date lssued !5. a 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 Regulationsc JOB ADDRESS/LOCATION k).,,r7j_... .. ...._. . . . CENSUS TRA . .... .. . ... Owner's Name '' �'�. S-ef- ` ....Phone ,/J ..�� Address /oma/ _. 1' �-r Cityt�(1.4� ,h''ls ......... ... .................. . Contractor's Name ..r.......... ---------------------------------...............................License # ... Phone Installation will serve: Residence)kApartment House❑ Commercial❑Trailer Court '] Motel Q Other ............ f, Number of livingunits•... .. Garbage Grinder 7 �--•--- Number of bedrooms a9 ..../....... lot Sized...'......... Water Supply: Public System and name .................. ...Prfvale Character of soil to a depth of 3A, r,, feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom E3 Hardpan 0 Adobe❑ Fill Materlaf ............ if yes,type (Plot pian, 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.......... .. Liquid Depth Capacity Ty`pedd ' ... MaterialC.d�i�^ N'r`. ..... ...................... -- Na. Compartments ....2............. Distance to nearest: Well 1/0. ............. Found tion ... .. ............... Prop. Line ... ..........- LEACHING LINE to No. of Lines ..2-............ ..... Length of each line.__.�,,j'.............. Total Length .../.._„?,�I. ........... 'D' Box ------ _ -- Type Filter Material ....................Depth Filter Material Distance to nearest: Well ..../ra_...�I.... Foundation -.L2Z............. Property Line ....,fid SEEPAGE PIT (lCj Depth c�-�r� ......... Diameter " ..... Number ......2----_---- ...... Rock Filled Yes No Water Table Depth .......a,S'Q..�. ........Rock Size ................................ Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# --------.----------------------------------- Date .................................. Septic Tank (Specify Requirements) ........................................................ Disposal Field (Specify Requirements) ---------- --------------------------------------------------•--•-------...--------........................... ...............•-----•- . raw existing and required addition on reverse side} 1 hereby certify that I have prepared this application and that the work wiff be done in accordance with Sen Joaquin County Ordinances, State Laws, and Ruses and Regulations of the Son Joaquin Local Health, District. Home owner or Iicen- sod agents signature certifies the following: "t cacti Pin the perfor ce of the work for which this permit is Issued, i shall not employ any persons in such manner as t sub(ect to k s Compensation laws of California.,, Sig ed ........ ..................................................... Owner By ........... ......... ........................... •------------- Title (if other than owner) DE RTMENT USE ONLY APPLICATION ACCEPTED BY .-.... ..._ _.....,_.. ... ..- ---------- --- . ..... DATE . , .v: -•a-`�--- --- BUILDING PERMIT ISSUED ---------------------- - ----- - ---------- -----.--....._..._......_... DATE . ..... ADDITIONAL COMMENTS __ ----------------------------- ............._......._--.............. ............... .... Final Inspection by: -- • ----•---........................................ .---- - Q ...................••----- ---•------------- -- -.._...._..._-•-••---........ Date .. .-- ...................... _. rte .. 111 13 2h 1-68 v SA , JOAQUIN LOCAL HEALTH DISTRICT 8/71 31K