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FOR, OFFICE USE: J ft h. APPLICATION FOR SANITATION PERMIT . .. ... -. _--._ - __ _ _ Permit No. W.--/.o-? 4 (Complete in Triplicate) This Permit Expires 1 Year Date Date Issued ........._ .._...-........... ••••- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 andtexisting Rules and Regulations. JOB ADDRESS/LOCATION .-� 1-�_•�._.._.. .. •-•-•- �� .�%G:�-L-Gam_... �._,--- - .- .- --CENSUS TRACT .......................... Owner's Name ... - - fi- r-- _--!- . Phone .................................... ..... .......:. -.- ........:city ---......Address � .. Contractor's Name _... ...License Phone Installation will serve: Residence ❑Apartment HouseL7 Commercial WraiVe ourt ❑ , Motel ❑ Other . .......1------------_ Number of living units------------- Number of bedrooms2Z ""-Garbage Grinder ............ LotSizeL ' ---------..-'.-..... Water Supply: Public System and name -------- -- :— ----- -----------_-Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat F� Sandy loam#❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes, type ......... . ......_--.-_-. (Plot plan, showing size of lot;.iocation of,'system in relation to wells, buildings, etc. must be placed on reverse side.)`1 NEW INSTALLATION: (No septic tank or.seepoge pit permitted'if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [rtei� y� ` ---- - - 9 P ---_--- 1 Size Liquid Depth ._.7 -- ----- Capacity /oZ Q C?.. Type)]_.? t -- Material Lfn No.' Compartments 1 r , Distance to nearest: Well .... � ________________ __Foundation _.Y -� . ___. Prop, Line LEACHING LINE [tr No. of Lines . ......./......... Lengfh''& each 'line' -Total Length -._-.yQ................. D' Box .... Type Filter Material '5 __------ th Filter Material .....f_e.............................. Distance to nea est: We ______ Foundation -�U..�..._... .:. Property Line 1 S.-i--. ...... SEEPAGE PIT [ � Depth __.;Z _....'--- Diameter3✓_.__...- .........Number ..._.._../............... Rock filled Yes (E No ❑ Water Table Depth . ........... _._._._Rock Size .. ._.-. ... _ .____.._._ `U Distance to nearest: Well _ -_.__.-.- ----------------------- .------ Pro -f , Foundation ..._ ..:... -- p. Line ---- ---------......-- REPAIR/ADDITION(Prev. sanitation.Permit ........ . ...................... - Date ------------- ................. ` } Septic Tank (Specify Requirements) .-.--------•--•-------------- 't... . f ............. _ J Disposal Field (Specify Requirements) {-------•--•--•- ........... ...... ....................... ia 1 .'. _ ....-----...---.... .i * -- ................... (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 cerfifies the following "I certify that in the performonce of the work for which this permit is issued, 1 shall not employ any penon in such manner as to becor subject_t0 Wk n's Compensation laws of California." s I Signed ....... Owner By Title _._......._....-_..._. .......... ......... .. ..... 1 ......... , (If other than owner) / k FO PARTMENT USE ONLY APPLICATION ACCEPTED BY :. .. ....... . . ....... ............ ...... DATE 2-j` 7� ..:--------- BUILDING PERMIT ISSUED - -- --`- / :......__...... .......................... DATE --------------------------------- ADDITIONAL COMMENTS . --------------------------------••--_-----.-------- i._..:....---i--------- _-.1 ' .......... ................................................................... ................_.. -------- . i . ._ 3IaI7Final Inspection by:�.- � `' .....................--•---------......-•------••-------- Date C dor BAN JOAQUIN LOCAL HEALTH DISTRICT � (7rcyt•u .l. Pr oPec��es �/ I E. H. 9 1-'68 Rev. SM