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FOR OFFICE USE: APPLICATION FOR SANI.TATION PERMIT •� f ............... ._..._........ ----. I -- Permit No. ...l.3"-5o'7 j (Complete in Triplicate) ... ... ....... .............. -----. This Permit Expires 1 Year'Fro:n Date Issued Date Issued .1 =1 . 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. 549 and existing Rules and Regulations- JOB egulations: ' .. .CENSUS TRACT .......................... . JOB ADDRESS/LOCATION ... ...-- .._ ..� � .td......:117. _... ...._.,fir..•.:....:....... . Owner's Nome ............. '. .._...... ._ �.........---- ------ Phone ......-........_................... .. .......... Address . ......_ .._....._ r••------•--. City .--------•-•--- ................... Contractor's Name ._.�....... .... . .. . , -----..License *,Z47Ls'/$?'/ . Phone,��`,�'{ G' Installation will server Residence iffAportment House E❑ Commercial QTrailerCourt ,❑ Motel F1 Other ......- -•-•. - ......... ...... ........... i P Number of living units:.... ... Number of b rooms .....Garbage Grinder- '_ lot Size A[..1o_..: kZ........ 1. 1... Water Supply: Public System and name ..,.. .. : � � . :.Private Character of soil to a.depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Gay Loam ❑ Hardpan E] Adobe '' Fill Material ----- If yes, type--:_.'....-. ...`- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Siz . q Depth ._ _ Liquid De ' CapocitylVCra f4—,Type1 ateriol_.. . .__. .. No. Compartments A..............:.. -- 6Distance to nearest: Well . _______________________Foundation .... --------- Prop. Line _.- ----- -- w O LEACHING LINE D( No. of Lines . _ g c �_ Length � � .. . _.... __ Length of each line..... .f'..:. ..-.-- Total Len th -- --.--mrd._.--._-•.-... 'D' Box Type Filter Material /? .--.._Depth Filter Material . 3 Distance to nearest. Well --------------- -------- Foundation Property Line ........................ I SEEPAGE PIT �(} Depth .o;�....... Diameter , . r... Number .......CA ...........:.. Rock Filled Yes it No ❑ � Water Table Depth ....... l ...... .......................Rock Size -.--. ._.-_--.--- .----_ r ' .... .........Foundation _.. ......... r Distance to nearest: Well .._. __..d.�._____,_ ._ .�� .._ Prop. Line _.�...._....._:t... REPAIR/ADDITION(Prev. Sanitation Permit# -------------- Date ...................... Septic Tank (Specify Requirements) ......:......................_.--------.....---......------•. -•---_....._..., ..... ........ Disposal Field (Specify Requirements) -- ----------------------------------------- ....................... ...... .......•--.................... ........-•------- ._...._.._._.... •........................................ ..... .. .... ...------- --.......------ ------- -- --- ---------- ... ------------- .... ........--.......... I r Mrdw existing and required addition on reverse sidel ' 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. Hoene 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 net employ any person in such manner as to become subject to Workman's Compensation laws of California." . Signed .:.............. .... .. .................. -----. Owner By _ ......... Title . .... (if other than owner) FO PARTMEN E—ONLY APPLICATION ACCEPTED B 4i .- : .. .. ,. ..._.. DATE .. I...�.P... ._..: BUILDING PERMIT ISSUED ........... DATE . ....__ ................•--- .. ---......_....--------- ----- . . ADDITIONAL COMMENTS ... . .. ---------- ..._• ti �_ - P . .............................. ---------------------------- .. , ti : ---------- ....... ------------------------------------ ---------------- --------I ............. ........................................ ___. ( _.._ ... ........ Final Inspection by: . � . . ............ -----------Date -- ' SAN JOAQUIN L AL HEALTH DISTRICT, F 14 13 241_'AA P.V 'SAA � � � 7/72 3 M � .�