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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1 � �- ......._._..............�_ ................... Permit No. (Complete in Triplicate) �' This Permit Expires I Year From Date Issued Date issued 7:�.7-,7� Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described, This application is made-incompliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. �1._... ,. _.�'.. ..c. _._..._;_...� 'f °......CENSUS TRACT ...................... lOwner's Name '_;.... Phone :............... Address .f .. `° !�. f1�. •- ��94 `. City ---•----.... .......................... Contractor's Name ... � /. .-. "._._. G- ...................... .................License # Phone W.2��".Zjo. Installation will serve: Residence$ Apartment House Q Commercial ❑Trailer Court Q Motel ❑Other ............................................ .� ` Number of living units __ : ______ Number of bedrooms _.'..._Garbage Grinder _._ ........ Lot Size �'..�...XJ .,e;°....._..__. r N Water Supply: Public System and name _ --- 1. "-- '<..............................................................Private ❑ Character of soli to a depth of 3 feet: Sand ❑, . Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ -Hardpan ❑ F Adobe'( 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 INSTkI LXTION: : {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} ' -,AEKAGE TREATMENT [ SEPTIC TANK T I Size................................................ Liquid Depth .............. ------------ Ca aci Type .................... Material...................... No. Compartments ........._ ............ k' Distance to nearest: Well ...Foundation --_-- Prop. Line LEACHING LINE [ No. of-Lines ....... Lengthof each line.------_---------------.------- Total length .............._............. 'D' Box ............ Type Filter Material .........:.........Depth -Filter Material ---------- ................................. Distance to nearest: Well ........................ Foundation ........................ Property Line ............. ` SEEPAGE PIT [ ) :Depth --- ................ Diameter ................ Number --------------•.............. hock Filled Yes ❑ Na Q F Water Table Depth .....Rock-Size Distance to nearest: Well.................'.......................Foundation ...._......:_.. .... Prop. Line .......... REPAIR ADDITION Prev. Sanitation Permit O Date .................................. fSeptic Tank ISpecify Requirements) ......................-......................................................................... .........._.— ------ ...----------- Disp�osval Field (Specify Requirements) ... ...---1 .... +. . y ,�i`•-..- .............................................• -•-----•-------------------------- --••--•--............---------------------------------....----------•---•---. .:......_...... -._�_- •. .. - --..---•.^.............................. (Draw exist ung and required addition on reverse side) 1 hereby certify that I have preparedthis application and that the work will be done in accordance with San Joaquin r County Ordinances, State Laws, and Rules :and Regulations of the San Joaquin local Health District. Home owner or lien- 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 �� k T. tlether than 'ownerl � Y - � .. � •. R DFP tqTMENT USE O APPLICATION ACCEPTED BY .... ..... ........... DATE .._ __. BUILDING PERMIT ISSUED .. r ..........DATE ............. I, ADDITIONAL COMMENTS . �-- � . ... '....... .. •............... Q. .l_Q.�. . �1 t -------------------------I............-................................ ------........._........:_._..._.. ............................................ •--...........--••---•------- -- • -- --•-------- -----------• .............................. ............ . .... •••............... ........:... ............... .......----................ ------ ..............I...................... .. �• �:......... ..... _.. ... . ---•------ •. .....I................... Final Inspection by ......................•--•--.....Date ..... �.._... ��. ..........._..-•---- . a -SAN JOAQUIN LOCAL HEAL H DISTRICT -_ p., �- • , F_ H_ 13 24 t_-eg Rev_ slid 7/72 3 M