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FOR OFFICE USE: r. APPLICATION-FOR SANITATION PERMIT t•3D - (Complete In Triplicate) P o. .._._._•..........- _ Permit N _�� 7 _....j....._ - : .... W• This Permit Expires 1 Year From Date Issued Date Issued .._.`..... ....... Application is hereby made to the San Joao in 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: J08 ADDRESS/LOCATION ,::...__�1� ` �= .._...._.. --• ---...._... CENSUS TRACT .......:. ... Owner's Nome ........ - Phone { -� _. .__..... &3 Address ........................�1 _.. n • -'......&.. .... City .. Contractor's Name ......... ... ... . � '.__.. � ......License # "_ _.-- Phone , ..` ..... ..... Installation will serve: Residence XApartment House] Commercial ❑Trailer Court ❑ • Motel ❑Other .-•------- . .,' Number of living units----_.. .:.---=Nuri trier of bedrooms ____.77:�Garbage Grinder ....P7-,_ t Size Water Supply: Public System'and name ___:.•.. - TPrivate C].....------ - - ---- Character of soil to a depth of 3•feet:.,,_Sand•❑ Silt❑ ,Clay '[] Peau❑, Sandy Loam ❑ Gay Loam ❑ t tHardpan ElAdobe Fill Material ..._E-_._... If yes,type ........................... (Plot plan, showing size of lot, locafion,of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic¢tonk=or.seepage pit permitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ) Size.........-----------------------------_---------_ Liquid Depth ............. Capacity — Y'""' ••. P y .._..------ •-• Type ---------------- Ca Material------------....._ ...No.,Compartments ...................... Distance to nearest: Well .Foundation�....�............... Prop. Line ______...... f LEACHING LINE [ ) No. of Lines ......:.. .............. Length of each line-----______-------- Total• Length --------------............... z 'D' Box ............ Type Filter Material Depth Filter M to erial i, Distance to nearest: Well __." ... ............. Foundation -.__ ......... Property Line _ SEEPAGE PIT [ l Depth .................... Diameter, ........... Number .. Rock Filled Yes ❑ No ❑ �,C Water Table Depth = _ } ,./ f i ........Rock Size ~ P .................. --•-_......-D t.ance..to_nearest:,Well_-__-••_•-_--•- ....._.Foundation ::4:. Prop. Line REPAIR/ADDITION JPrev. Sanitation Permit# ______________ Date _ Septic Tank (Specify Requirements) _.... ._.. --- :..._..._... __. r Disposal Field (Specify Requirements) __...... ........-__•_, K _ ................................ 2._-�:.......---- . . - yl._-•-------------- ..... (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 a County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne 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 shalhnot,employ any person in such manner as to become subject to Workman's Compenso' donlaws;of California." Signed .. Owner {I o er t owner SPAR TENT-USE-ONLY 1 APPLICATION ACCEPTE BY__-_ . ._ ._ ... .. ••. -- --•• •-•- ......... DATE . .:... f BUILDING PERMIT ISSUED ... .... .. ...:...... ... --•-=---••---..._.....--••-------.._...:.......•----.-DATE ADDITIONAL COMMENTS .. ...... .. ....... ..: ..... --- --• ---•--••---------- . . •: . ..._ .....•• ------ .... ..... .. ...•_•__•--•_ ..-____•_ ......... ....., :..........��.. , ...................._............_._.._.........--- G: ••__••---- ............ ................. --------------- Date - :7 • y--_=,_SAN JOAQUIN.'L'OCAL"NEAiTFi-DISTRICT °� E.H.13 24 1.'68 Rev. 5M 7 J z 1 'A u