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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT No ..............................................----• -- - Permit ,� •:,• (Complete in Triplicate) � ---------=---------------------------- •--------•-__---•- Date Issued ---------------------------------- This Permit Expires 1 Year From Date Issued 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: CG-L••-G•-N--- �GGI CENSUS TRACT -------------------=------ JOB ADDRESS/L -------� I t ( Owners Name---::/ ..... -G-E--:-... /.� A-R-c ...................Phone ---- ----------------------- Address .............. (7O'i --------1� G.1----------•-- City _:..__� ! ------------ •-•--- 7y/ . G.g-Gi� _._ Phone t Contractor's Name *SM j -- .license # t ' Installation will serve: Residence XApartment House❑ Commercial:❑Trailer Court ;❑ Motel ❑Other._._ _ - ------------------- �___ - 1 Number of living un`its:._... _ --- Number of bedrooms ____ .._.__Garbage Grinder ./vA_-__ Lot Size ____ ___ ____ _ _e PS__..__..--_•- - 1 Water Supply: Public System and name _______________________ ------------------------------------_-•---------- -------- Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam:[] Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available_within 200 feet,) O PACKAGE TREATMENT ] SEPTIC TANK.T ] Size__________________ -------- ...... :Liquid Depth _...._.._._.__._..._.__.__ capacity 1 Type -------------------- Material----------------•_---• No: Compartments -----_.----------_•-- 7 p tY -------------------- YP Distance to 'nearest: Well __________________________••--_--- Foundation .... .__.fir^- ----- Prop. Line ____..._•____:..-_--__ l LEACHING LINE•� [ ] ��a. of Lines --- - - - ----------- Length of each line---.__._-_--_______---�-'- Total Length :__._...___._.._____.___-• ' - v 'i 'D' Box ...__- _._ Type Filter Material ____________________Depth Filter,/Material ------ ----------------------------------- 3 �5 �.f 3 Distance to nearest: Well ------------------------ Foundation ------------ Property Line. ------------------------- SEEPAGE PIT [ J �Depth ____,.;�'-...-_-_-_ Diameter ___-------_..... Number ___,___.°.__..._._-_._______ Rock Filled Yes ❑ No .C] ( , S'I Water Tabl4bepth ----••------------ ---•"- =---------•-•----•--'Rock Size . x'y f Distance to nearest: Well ---------------------•_..__..-----':Foundation --------------- Prop. Line ...................... I REPAIR/ADDITION(Prev. Sanitation Permit t# ___________________________ ••=•---•__--1 Date -------______--______-_---__-_••'1 � Septic Tank (Specify Requirements) -.--:---•-• -•.1 --------- -•---- f ... � / ;`- j � Disposal Field [Specify RegiJirements) .._ ------•-•------__,_--•- - •-------------• ................ L.. --•--•--------•-•---- -- _...`--------------------- (Draw existing and required addJjion on reverse side) '�• � I 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 San Joaquin Local Health District. Home owner or licen- sed agents signature'certifies the following: I — j "I certify that in the performance of the work for which this spermit is,issued, 1 shall not employ any person in such manner as to become IecY to Workman' mpensation laws.of Gcilifbrnib.." • - f ........ t i Signed .-_ Owner I ite BY ----------------------------------- - .................... ----------------------------- T 1X', ....� l (If other than owner) T _ _ 4 1 ( --AA. FOR,DEPARTMJNT USE ONLY -. _ .. ..-- APPLICATION ACCEPTED BY -- -- ---- - 1-- -- -- ------------- DATE ------------------------------------------- BUILDING PERMIT ISSUED ------- ----------------- DATE ADDITIONAL COMMENTS ..................��.-__,_,q� .._ ----------------------- --'---- = ------- ----- -----•---•---• -•----. ------- ---------_--- '-A.....--•------••-•---•----_..__.._._.__...---•-••-----------. .. ---------------- ------ ------•-... --•------------------•-••----____-_-___________-__-----•---•--•----- Final Inspection by: ---•---------------------- Date __.._.�_. .._. SAN JOAQUIN LOCAL HEALTH DISTRICT ( �. E. H. 9 1-'68 Rev. 5M.