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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................... . (Complete in Triplicate) Permit No. . ............. . This Permit Expires I Year From Date Issued ................... .... Date Issued ....."/..._.. .. Application is hereby made to the San Joaquin Local Health District for a described, This application is madl!e i complCia�nce/with County Ordinance No. 549 and existermit to ing Rules and tand t Regulations:he work rein JOB ADDRESS/LOCATION ....CENSUS TRACT ' Owner's Name ...........!"1..pa'-1--?.a.�_.'.�-t d. les _....... ......-----�-----••--•.................. ... Phone ...................�. V 11 TL Address .......... �. . .5. .F..� —��' ... city . . ..-- Contractor's Name ........ W'ti.�_'✓---- ... .. ........................................ ----- --------------- ------•----•--------...License # -.._.. . ............. Phone ... -- Installation will serve: Residence Apartment House-E] Commercial []Trailer Court [] Motel E]Other .......... .. .. Number of living units-.,------- Number of bedrooms ....__.Garbage Grinder ."4_.Q.. tot Size PPY� --- Water Supply: Public System and name _. 9 ....... --•............................ ..-----.. .._. Character of soil to a depth of 3 feet: Sand ............... ❑ . [1 Silt❑ Clay [] . .--Peat E] Sandy loam E] Clay Loam n Hardpan �] Adobe kA Fill Materia! ...-.....__. if yes, type ................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side. N INSTA TION: (No septic tank or seepage pFermitted if public sewer is available within 200 feet,) )PA GE T ATMENT j SEPTIC TANKT l ( ! Nizi------- -- ---•----• - - ---•---- --... Liquid Depth ..................... Capacity .- TYpe -------------•_ Mat rpia)_..._....._.-.---_--- No. Compartments Distance to nearest. Well ------------Foundation ..................... Prop. line --••--.— X LEACHING LINE O No. of Linesr Length of each line ......7.5...,- - ------ Total Length �. D' Box ......... --•--- __.._... Type Filter Material -. PLjk.....Depth Filter Material ...y.�........... ... 1 Distance to nearest: Well _��rti-C'------. Foundation .../-5,-�_ -•-. � � ' SEEPAGE PITDepthA �.I t ..... Property Line _.�.� Diameter ---y---...._- Number .._..:�. ..-..- ------ Rock Filled Yes ) No {]� Water Table Depth .-__--_.12-0- ----------------- ----- _Rock Size Distance to nearest: Well ----------- ----- . Foundation ........... Prop. Line .............. REPAIR/ADDITION(Prev. Sanitation Permit# ........... ....... t .....,..--- •-•--•--- Date .................• -•- - ....) h Septic Tank (Specify Requirements) - ----- - --------- Disposal Field {Specify Requirements! ----------- (Drd'w existing and required addition on reverse side) CountI 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. Horse owner or lie y agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued I shall not em io an as to become subject to workman's CoMpens tion laws of California." p y Y person in such manner Signed _: ............. U.CpC - (if other than owner) ----------------- ---------------._-e+ Title ......................... FOR DEPARTMENT USE ONLYAPPLICATION ACCEPTED BY ._.......�.-'._ j _ BUILDING PERMIT ISSUED .-..:.._.......:.- -_ ----- f -•-... .. DATE ADDITIONAL COMMENTS _..- �...... ........... . ... ........._-.-•------• -----• ................. ._ .. .. ....DATE ....... .......;...__.......-----•--- ..............:. ------•-------- ------------- ------------------------------..---....----...... ..................----••--•-------.-............................. Final Inspection b . . -- . - -- r- ------• ....... --•.................. gg - -•---....Date'.2l�r� I till Oil+ ^1 , SAN JOAQUIN LOCAL. HEALTH. DISTRICT E. H. 13 24 )--'6i Rev_..5M _ .0 r5