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FOR OFFICE USE:: < APPLICATION FOR SANITATION PERMIT ........ ................ ....._.. ........ Permit No. ...... (Complete In Triplicate) ...... ................................ 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 : FNo. 549 and existing Rules and Regulations JOB ADDRESS/LOCATION ........-3.g d O e N IV e r'J .CENSUS TRAC"f - Owner's Name .........' /�!f S ... ---•��-,�1V_C ................:.......... Phone ........_..-......_._...__......._. Address .... .............. ...................................:............................................ City ---�� " "'`.. ...----•-.....................---............_..... /G6--S G Phone �/.. Contractor's Name .....! .- l1l _h.:QlX [."_.... ._._ �?N------------------------License # -..-.....- ..__....._._ x Installation will serve: Residence JE Apartment House 0 Commercial []Trailer Court a living un�ts:_....�..--. Number of b❑edrooms... .......Garbage Grinder .....__..... Lot Size ..`.'�._�, Motel Other ----- -----------------_------•--......... Number of g Water Supply: Public System and name ------------------------------ •------------•----_-_.._---..................................................Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lq Clay Loam ❑ l Hardpan ❑ Adobe-0 Fill Material ............ If yes,typeI (Plot plan, showing size of lot, location of, system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: 1No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i PACKAGE TREATMENT ] SEPTIC TANK[ ] Size................................................ Liquid Depth ......._.- , ......... CapacityfQCrNo. Compartments ..�....—................ .�Distance to nearest.. Well jav-(.............Foundation ...................... Prop. Line . _ `a w LEACHING LINE [ ] No, of lines _.. ............. Length of each line---------- - Total Length , C� D' Box ...1.._.. Type Filter Material ��----.-..Depth Filter Material .. / oe Distance to nearest: Well .../.............. Foundation --. Property line .`�.......:..:::_._ ' �p .-- . k .i SEEPAGE PIT ( 1 Depth .................... Diameter ....... ........ Number --.... Rock Filled Yes ❑ , .Na-,'Q ' s WaterTable Depth ---•-••--•- ....................................Rock Size ............................. i ......-- Distance to nearest: Well _.Foundation ... Prop. Line ' REPAIR/ADDITION(Prev. Sanitation Permit# ..-•---•----•...... ......... .............. Date ..................................I SepticTank (Specify Requirements) ....................................._..........__------------------------------------....................................7.................. . Disposal Field (Specify Requirements) .....,....................................................•——---------------------------------------•-----••--•-•----•---•-•-• :... ----------------------- ............................... ----------------------• -•-•----------------............................................... ........................ lDraw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in -accordahce with Son 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 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 1-2Ao-)`/� d/VV 'd Yd:?1/ Owner _./ f . �itie By ............... . ....-----......_......_....._........._......------ ._---• (if otherqtE _ F R IEPARTMENT SE ONLY DATE _. ._ APPLICATION ACCEPTED B _...... . ...... .. ... : :. ........................ g` q BUILDING PERMIT ISSUED ------•=--••--•----------------- -----------------•L•••-----•---•------------•-•---..-_._...............DATE ........................:.................. ADDITIONALCOMMENTS ........................................-----------•------. --------*.........._................................................. ............................. .......................•----.._... .....r.... ... _................... Final Inspection by:,�.._. �.f � - ...................................... :........................Date _..( '. ..._ ................ l r l/ SAN JOAQUIN LOCAL HEALTH DISTRICT , _ .. 1 1 9r 7/72 3-M