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FOR OFFICE USE: APPLICATION 'FOR SANITATION PERMIT f (CPermit No. .. . (Complete in Tripllcatel This Permit Expires I Year From Date•Issued 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: JOB ADDRESS/LOC TION •. .. _- r • . ,�..,Q. _,��!.,!7I. 4pr ........ CE _TRACT Owner's Name .� .:--/- .......Phone4 _ ztl........... Address .............. _/ a . City:..--••--••. -- .................../ . I Contractor's Name ........ ............... a'..�J'dre� License #,r? :. .1� Phone -r.�G7 ... Installation will serve. ;Residence []'Apartment ljouse{] Commercial❑Trailer Court Motel ❑Other Number of living-units:............ Number of bedrooms _............Garbage Grinder .._ ........ Lot Size ......................................... --- Water Supply: Public System and name ............... . . . . .. .....Private ❑ Character of soil to a depth of 3 feet!' Sand❑ -, Silt❑ Clay E] Peat❑ Sandy Loam ❑ Ctoy Loam ❑ Hardpan ❑ Adobe)' Fill Material _:.......... If yes,type .--------------------- Mot .__._ ::*._ --..:.{plot plan, showing size of lot, location of. system in relation to wells, buildings;etc, must be plaeed•on_reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200'feet,) 114 t PACKAGE TREATMENT ( � Sf;PTIC TANK ( ] Siae....:....... ..-.-- _- Liquid Depth 1 ... Material - - i^� Capacity .. :. TYPe ................. --I.....---.�No. Compartments ..........._...._..... _s• Distance to nearest: Well .....................•..............Foundation .................___-- Prop. Line ...................... LEACHING LINE O No. of Lines ................ ..... Length of each -line.--- ___.-----:----------- Total Length .. _. 'D' Box ----- ,.... Type' Filter Material ....................Depth Filter Material ............:........................... : Distance-todneorest: Well......................... Foundation .... __ Property Line ................:. . SEEPAGE PIT Depth _..t.._...►.``. __ ...:.... Number ....... Filled Yes0 , No - Water fable Depth '_:__...�' . ...:...........Rock Size " Distance to nearest: Well } ,,. :...........................Foundation ----•----•- ........ Prop. Line ................ _ REPAIR/ADDITION(Prey. Sanitation Permit# pate ...................• .........---•--• --.. ............................. Septic--Tank (Specify Requirements)...............:......... ......................./.�...�...`........�.....• - ; Disposal Field (Specify Requirements) ..............�"t�._ C9.__•---- Q_.-.-• J w�it9 - ��L _- _--------... _ -------------•---- --------------- .........................•-•-------.. :. - _ K ,� �- . .. x ----------------- -----------}------•-------...----------...-----------------...._........... existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin unty,Oidinances;State-Laws;and Rules and Regulations of the San Joaquin local Health district. Home owner or licen- -;; = agents signature certifies the following:- ' reify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workmon's Compeniatlon laws of California." Signed ---- ' Owner t , 1 s i- , BY f f .'.:........ :.::::.. .. Xitle .... 4 (If oth r han owner) `" .OR FPi,R1'MFNT USE ONLY APPLICATION ACCEPTED BY ........ . . ...:. .:.. ...............DATE .... .. BUILDING PERMIT ISSUED ........ ADDITIONAL C MMENTS _._.. •--- ....... 3 E ...__ �S ..._.� by ... ..Date Inspection . ' •. -- ....... _ ' . 7t> ........... j % ��'•1 n . ..JOAQUIN,RLOCAL'-HEALTH DISTRICT E. H. 1.'68 Rev. SM