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FOR OFFICE USE: g a lT 54 ose APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..�7.....�_�G ---------------------- This Permit Expires 1 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"bpplication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ��Jva �n�RI I-T':-C.E.!'If.CENSUS TRACT ......................... Owner's Name . . f..�' ....._........ .r✓c l) .'._��.................... ........ ..._......... .....................Phone .................................... Address ............................................City 5..,V............................... ........... Contractor's Name ` A) TA 6'c ,Y "� �'��'' License# • . - .._ Phone �''� ' Installation will serve: Residence JRApartment House J-] Commercial ❑Trailer Court 0 , Motel ❑Other ............................................ fc•� Number of living units:.....�'..... Number of bedrooms ....f......Garbage Grinder ............. Lot Size ..._..__..�vX._ ..-.... ........_......... Water Supply: Public System and name ......�:.'T'.R Private ❑ .__... .... -.... ......... ............... Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam 0 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 onreverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT [ ] SEPTIC TANK f j Size................................................ Liquid Depth .......................... s Capacity ....... TypeCr�f p a .....r�:..._.....�. Material ''^"�-... No. Compartments . ?i............ ._._..Foundation ...._./.�' 4 Prop.Line ....:f. ........ Distance to nearest: Well ............................. ..._..__.. .. 50 LEACHING LINE [ j No. of Lines ` J'ey / c/' Length of each iine..�! .t' *�d ... Tonal Length ._•......'.........a ., 7 D' Box / Type Filter Material 2�155A•s' Depth Filter Material ....................�{ Distance to nearest: Well ........................ Foundation ...-. _ ......... Property Line ._ .�... . ....,.. SEEPAGE PIT [ ) Depth -------------- -- Diameter ................ Number ............................ Rock Filled -Yes ❑• No Q Water Table Depth .................................................Rock Size j Distance to nearest: Well........................................Foundation ..................... Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. SepticTank (Specify Requirements) -•--•----•---...-•-------------------•---•-•-•--...-•----...---•-•---.........................._..........._............._......... Disposal Field (Specify Requirements) .--•............................•-----•-- •- ----•_._ ....--• --_..... .:......_........... .._....:_............................................... • V ------------ -_------------------- ........................................................---- ----. .__-.. .....-- . .------------._._........- . ....__..............----•---... ....... ............. _.... (Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared this application and that the work will be done in accordance-with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health Diitrict. Home 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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed 7- Owner o�v i osis ............................................ By _ .. .- ..... -e" ............................................. Title ......... ..... ................-...._... ._. .-... .... (if other thanYownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..-- . ...... .................................... DATE, :., G�= '7...... BUILDING PERMIT ISSUED ....................•__......._.__.._._................... ......_... ..._.........:..:,,DATE ADDITIONAL COMMENTS Final Inspection by: ................. .........................................Date ... 1 7 ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 ev 7/72 3 M