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FOR OFFPCE USE: APPLICATION FOR SANITATION PERMIT R^ S3-� (Complete in Triplicate) _ Permit No. S ........ ..................................... ............................................A............. 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 �O rexisting Ru s and Regulations: (7R�N S-5-JOB ADDRESS/LOCATON � ..CENSUS TRACT ..................... ..... Owner's Name .�i_4°. ........Jcws' P&.........................................................:.....................Phone .................................... Address ...XCt7....../... . . ................................................... ..... City ...l. ! ..................................... Contractor's Name .... /�A.N..T..a./.V. ....3�... .lr..�N..............................License #IIS�t."�S'G..... Phone-15;2-7.r...`.............. .�� Installation will serve: Residence IN Apartment House 0 Commercial ❑Trailer Court ❑ Motel ❑Other ............................................ , Number of living units:...,...... Number of bedrooms .... . .. g SOX ��C' pp .Garbo a Grinder ............ Lot 5ize ............................................ Water Supply: Public System and name ........ ... ................._.................... ..............................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay loam ❑ Hardpan ❑ Adobe Q 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.}i:�r:/ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer available W10"200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f J Size................................................. liquid Depth.......................... Capacity .................... Type .. ............. Material...................... No.' Compartments .................. Distance to nearest: Well .... .............................:Foundation ...................... Prop. Line LEACHING LINE [ j No. of lines ........................ ngth of each line.........................:... Total Length-................. ......... 'D' Box ............ Type Filter M tenial .. ......... ...Depth Filter Material ............................................ Distance to nearest: Well ...... ................ Foundation ........................ Property Line SEEPAGE PIT [ [ Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 tl. Water Table Depth ............Rock Size Distance to nearest: Well ...... ..............................Foundation .................... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit�# ............... ........................ Dote .................................. Septic Tank (Specify Requirements) ............................. ...............................................•.._......................... .......................... Disposal Field (Specify Requireme s) .... :..... s ...-- •... 1� e .,Be. �1 c/ 1 ra © ,� s ih rte- .. ............. ................. ., ....... ---..... ..---•--------.... ..._, ..._.... ......................------•......-----. ..------........... .. ............. (Draw existing and requirecl 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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health Oistrid. Home owner or Iicen- sed agents signature certifies the following: E "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation rows of California." Signed .....!� .�NT��. . .....T'..54./Y............ ......................... Owner B .......................................................... Title ........................................................................ he vn FOR DEPARTMENT USE ONLY O, APPLICATION ACCEPTED BY DATE �.�....:7 ' r BUILDING PERMIT ISSUED ...DATE ADDITIONAL COMMENTS ... . . ............................................................ ...................................... ......-- .................. . ........ --_.... .... ............---............................. .................................... ..... ..................:. . ...... ......._.... .. . .... .. ........................................ .......... _ ............ !T. Finallnspection Date f i SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72 3 M