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FOR OFFICE USE: !-APPLICATION FOR SANITATION PERMIT � 7 (Complete In Triplicate) Permit No. _ ....... �...... , ........................................................ t r 4 . � •-� Date lasued � 7......... I .....................................:................... ThisPennitExplres 1 YearFrom Date Issued _ 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations- JOBJOB 1 AbDR1rSS/LOCATION�i�.__. ,t�la: . i.......... ......t. .. ...............CENSUS TRACT .......................--- Owner's Name G.C._-.- __lvfl.- ............................._ _ _:-- :" ... "`"..�„°. _:.Phone .................................... Address Ff ✓l / c^ •-, Cl ,� City ..................................................... - Contractor's Name -----------License # _347Phone Installation will serve !Residence Apartment House 0 Commercial❑Trailer Court 0 i ' Mate] j]Other Number of living units:_..-_-_-._ Number of bed rooms Grinder� .....-.. Lot Size .......................................... ..�.....-•--•--•-•--. _........................................ Water Supply: Public System and`name __ ..........................$ � ° " ..Private ❑ , Character of soil to a depth of 3 feet `` 0Silt Q Clay tQ Peat❑ , Sandy Loam'€[] Clay Loam 0 Hardpan❑ Adobe 0 F"ill-Material.......#......If yes,type............... ............ Lu (Plot plan, showing size of lot, location,*of system' '€n 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 ....... ....... Leif/r u Copocity��.—00---_.--- Type. Material_��- No. Compartments _ ..2 Compartments Distance to nearest: Well _.-------.... .....................Foundation ._..---__.-.___---- _ Prop. Line .......... LEACHING LINE [ ] No. of Lines ........................ Length of each line------_- ........._.------ Total Length .... ................... ...........bepth .Filter Material ................-•--•---..__............i... 'D' Box ............ Type filter Material ......... Distance to nearest: Well .__...__................ Foundation _..._...._...__.._._.... Property Line ,........................ SEEPAGE PIT [ ] Depth .-_- •------------- Dia a r .---•-- .._...._. Number ..-_....._..__......_....... Rock Filled Yes ❑ No Q Water Table Depth .. ••--------------------------------•-------Rock Size ................................ Distance to nearest: Well .........•-------------_--------------Foundation ------------------- Prop. Line ........--.•. ........ - REPAIR/ADDITION(Prev. Sanitation Permit# -------- ............................. Date ----------- ............... ) , F Septic Tank (Specify Requirements) --------------------------------------------- Disposal Field (Specify Requirements) ......14<:�T-- ...... Q = S --------------------_-----------------___---------------------------------- _ ____._______-___..__...........__ ._____...__._____...._..............___.__.______-..- ... (Draw existing and required addition on reverse.side) I hereby certify that 1.have prepared this application and that the work will be do-no In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health:District. Horne owner 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 ------.._...... •--.•-- •.... --•----------------------- ---- E (if other than owner) I _ R ART ENT USE ONLY APPLICATION ACCEPTED BY._._...,_._ �� -- DATE . BUILDING PERMIT ISSUED ------------------------•---...-----•---................ -----------DATE ........ ................................. ADDITIONALCOMMENTS ------------------------------------ ------ ------ ...................____-------------- --------------------------------------I..-•---.._...------- ------ _.._......--•--------------------------------------- -- ----- -- ---- -------............................ -•--- ------------• . ---•------ ••-•-- -•-•- ---- •------•----........ ---------------------------------------------- -- -------------- ------..._ ----------------.... ....---...-----. -----• ------------.------- final Inspection by _ .r ..........Date . .. �. _. .--._. --•---------- q r . � EH 13.24 1-68 � SAN JOAQUIN LOCAL HEALTH' DISTRICT $ 71J 3M