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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _....._. (Complete in Triplicate) ............................................ ,� 7L Date Issued ./.e:.:.....:...... ......-__. This Permit Expires 1 Year From Date Issued 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 Cou Ordinance No. 544 and existing Rules and Regulations: - ' JOB ADDRESS/LOCATIO. .._.. _..._ ... ...._... `-¢` .....---- ................CENSUS TRACT ................... 0 ne. ...., Owner's Name .. .... nn r- ----------- .ems Address g.7 A GtyP one •-- -- F Contractor's Name _. , . ,° �- License # .. - Phone .................... Installation will serve:` Residence [?fAporimerit House[ -Commercial j]Trailer-Court...C]- Motel 0 Other— .. = — `_4...... Number of livingunits:.:... Number of; bedrooms,_.;, Garbe a Grinder ; Lot Size --'----- --------- Water Supply: Publit System and name . .. . .. . .. ... - .----Private --- . Character of soil to a depth of 3 feet: Sand Silt{] Clay:. ❑ Peat j] Sandy Loam Clay loam❑ a P `: . i Hardpan Adobe Fill Material _ . If yes, type ... Y .......... ? . (Plot plan, showing size of..lot,,location of-system m ;relation to.,wells, buildings etc mutt -be placed on;reverse,side:) NEW INSTALLATION: (No septic:tank or seep ge pit 'permittee( if uhlic s6wer. is a`vailable�witl in.2b0 feet,)' PACKAGE TREATMENT [ ) SEPTIC TANK Sieh -- g! X.." ._�;.. . ` Liquid Depth _.'1'�..�.............. . # I 1 Capacity Ja 6 ss Type ... Material..<.6-- L__ Comport ............ s.a No Compo 3i Distance to nearest: Well ' ---------Foundation ... ! B Prop. Line. [y� , Length of;each litre --a . .. Total Lerigth. .1.- LEACHING LINE No. of Lines . D' Box f TYpe•kilter Material -� .::_.:Depth ;filter Material r ........................�•-•-= s Distance to nearest: We11 .."J.' iFoundation r Property Line _ . �.D SEEPAGE PIT { Depth -. -': Dipme`t'erI :..�Numbe, Rock Filled Yes [ No E . . cWater Table -- ..tok Size.-- . --• -• - Distance to;nearest::Wel! ..__.....�:J`2`3-P ..Foundation: Prop Line'.._. �.`� I REPAIR/ADDITION.(Prev. _ Sanitotion:Permit :Date : ; .-- Septic ------------ y F. Tank (Specify Requirements) :._._ '_..-" ----- -- ................ Dis osal Field (Specify Requirements) 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 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 .:.. ..............:. ...... ... Owne By --- _. . .........:.,. �"�`c�C, Title ...- . $ (If other than owner) }. FOR DEPARTMENT USE ONLY ��-�- ------_-...ter-- --- APPLICATION ACCEPTED BY .......... . .. _i...... 1� .:..-... _.. :---- -. DATE :...f..2..`L. �.r�.�._._... BUILDING PERMIT ISSUED .............. . ----- ....DATE iADDITIONAL COMMENTS ....... . ---- - --------------.--I.._.-- ..... ........ .. ............................................••-._:.._-.--------...._... F -------------------------'--..,...- .........................••- .......................--•`-----------------------..................... -----..__ . Date ..r.Z:.� . Final Inspection by: SAN JOAQUIN LOCAL. HEAL7H� DISTRICT 7/72 3 M