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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................................ ..... Permit No. (Comp lQte in,Traplicate) ..............I.......... ........... ............ This Permit Expires 1 Year From gala Issued Date k Application is hereby trade 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. 549 and existing Rules and Regulations: j - r�= < _JOB ADDRESS/LOCATIO ..-..� �.�-..-�..-. .�.rl -• - - ----. -. . ./........-ter!.-.-..-.....CENSUS TRACT ..-------................. Owner's Name ..:. e -Phon i � r .. CifY .-....... ..Address _.._...-� Contractor's Name .. t . -. . .. ._!J.::_- _-.License # c V7124 .._ Phone -Zxxaat Installation will serve: Residence O(Aportment House❑ Commercial ❑Traller Court 0 Motel ❑Other -..••------___................ --------- Number of living units-----/--.- Number of bedro ms ..Garbage Grinder .:: Lot Size . Zee __ _ .._-....__._.___._. Water Supply: Public System and name -..------- -------- .......... ..............................Private I Character of soil to a depth of 3 feet: Sand❑ -Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material ............ If yes,type .......-------•--•---------- F (riot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) n N ;INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) AGE TREATMENT [ SEPTIC TANK Size. y�,Ln .�k_�+r..r._._._-. Liquid Depth ..... --_ `'"Caacit p yl,�'-.-.- -.._. Type 1, . Materiai._al. No. Compartments ....... ...0 • f f Distance to nearest: Well ...., ice-----------------------Foundation ... ............. Prop. Line .._�_._...-- ......- 3 LEACHING LINE K No. of Lines r r - . Length of each line..-... Total Length .......... 'D' Box L/..'..... Type Filter Material _ ________Depth Filter Material -_•el�_F-..._____-------............. I Distance to nearest: Well .. ......... Foundation ...A __-.. .-_. r,` -.-. Property Llne- .__._._'07_.•-.._..._-• ' SEEPAGE PIT Depth [ .P.... Diameter , ��_ ............. Rock Filled Yes, No Number _ -_--. ❑ ?: Water Table Depth , f ....... ----Rock Size .............. J Distance to nearest: Well .../2fa-__--_____________________Foundation ..a<°4 ._....... Prop. Line ...C-____.__-------- REPAIR/ADDI=ION(Prev. Sanitation Permit# ..........................___•.-............ Date -------..-....-.....__---- ....... t 4 Septic Tank (Specify Requirements) ...••-....--•----•.............••---•------------_--- --------------•--------•-----•----------•-----_-............. ---------•........ ...... rt J I Disposal Field (Specify Requirements) ...............••-----........... -------•••---------------------------------•-•--•--.._.......------•--•-----••---•----•-•.......... ----------------------------------------------------------------------------------------------- -••-- ........• ............................................................•-•--•--.............. ..._ I ---------- -------------------------------- --------------------------- .-.-...-._..--------------•----------------------------------------------------------------------------I—----------- (Draw existing and required addition on reverse side) 1 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, 1 shall not employ any person in such manner t as to become subject to Workman's Compensation laws of California." Signed .......................... -•--••-•------ • Owner Title ........... !d..................... f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .-...__.-.. _ DATE .-� ...�..7� BUILDING PERMIT ISSUED ... DATE ADDITIONAL COMMENTS ....................................... . .. ' ----- .......... ... .--. --•----......-•------....•••..............•.._._.__ ..•--•-..__..___.-••• .................... .... .........7.. ... ---••--------- . ----------•-- -------------........._ ---•............................... ....... ...... ':.:..... ..... ................. --- -- - ---- --- Final Inspection by: ..... ..... .......• ....... ate . N JOAQUI LOCAL HEA H DISTRICT ;` w 13 24 ,-'AA D6- 4AA 7/72 314 r =