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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT _...-. - Permit No. ? -........ t (Complete in Triplicate) , P#/-V- This Pmit Expires 1 Year From Date Issued Date Issued ....5............. _......... ............................... ...._.. er j 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 County Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATI I ... .... . .. ...... -_.. .. . .......... . . .......CENSUS TRACT ......... ------ ...... Phonef�< Owner's Name --- ----- Y ........... Addressn - ___._-------..__.__ }city___..._._w._._.:,._. __..... . ..3 " Y s •-- Contractor's Name .. ............License # .y.:��. .3 i. Phone _Y..... . ..._ 1 Installation will serve: Residence-( Apartment-House-[] Commercial ❑Trailer Court ❑ ' Motel Other { ' Number of living units:.. ,,.1.. . Number of bedrooms --- ---Garbage Grinder ..... ._ .. Lot Size'..� _..lr.�f..:..................: ( Water Supply: Public System and name ...........f. :"*:'�- . .... . .........^--_.�: ' � ' Private Character of soil to a depth of 3 feet: Sand❑ Silt El It r-1 Pe t'❑ Sandy Loam ❑� Clay Loam ❑ Cal �^ Hardpan Q Adobe Fill�Materral ..... -i If yes type - ----- -•- (Plot plan, showing size of lot, location of system in relation td wells, buildings, etc_must be placed on reverse side.) X4`41 I, , t NEW INSTALLATION: (No se ptic tank or seepage p,ii,.permitted if public sewer is available within 200 feet,) F—SeR , PACKAGE TREATMENT [ ] SEPTIC TANK[ ] � - Size.-.--. ........ ..... .... .......4_-.-_ Ltiquid Depth ._._...._...._......__... I t� iaE ►J No. Com artments ................. Capacity .. _� .. Type . . �._......-... --- Material,_........,. _.. ._ p ..... Distance to nearest- Well . ----.__Foundation .- . .. ..-.... Prop me ----- ............... LEACHING LINE i ] No. of Lines Length of each Eine ._ ..... ''�Toal Length ............................� 'VA I e, .De, th Filter Material ......... .................................. . D' Box .._. Type +TiFte� Material ------ ----- ------ p I I �.=5 _. Property Line Distance to nearest.-W611 •----�_.............. Foundation ... ,....._. . .......... SEEPAGE PIT [ ] Depth( - Diameter��' .------- Num .... Rock Filled Yes ber ....`---- C] No C3rt ) J I ! rt �I. Waters Table Depth/. •-- --•------....Rock Size ... - Dista ncerto�.nearest Well -".._....-----•--•---.......------ -�-:-��Fovndasion'" _.. ... _ ... Prop. Line ... ...........:......... REPAIR/ADDITION(Prev. Sonitation>Perm f`# .' •.._ �------ r... Dare "."fes. ------- ` ----- ----- 1 I fit',Ar .ew9t .._......_.i.....__....._....._.... Septic Tank (Specify Requirements) ' Disposal Field (Specify Requirements) ......"= __.. . --- - -- ---------------- ---- --------- -.... .. .... ....... --- lDraw 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 SanvJoaquin local Health > istrict, home owner or licen— sed agents signature certifies/the following- "I"I certify that in the performance of the work for which this permit is issued, I shanot employ any person in such manner, as to become subject to Workman's Compensation laws of California." ( --— .- -- Signed .: .......... . .... �.._... --- -- • -...----------�.--:-:..,-_: ...--...,-:-_-.�_-:.:�_�.Owner..,...,- By . .. . I tie _ c...... k { o er Than owner) F R DEPARTMENT USE ONLY APPLICATION ACCEPTED 'BY . 7 ......_._. DATE . BUILDING PERMIT ISSUED ...... -._._. DATI` . i ADDITIONAL COMMENTS ,......._.._"....... .. - } ..............----------.--- ---- -- - -------- ] .. ..................... --...... •• Date Final Inspection by: .......... = a 4 SAN JOAQUIN LOCA --HEAL-TH"'DISTRICT . .L . 7/72 3 M c u 13 241_ ISA Rem rAA -