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r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...7. �`•• ...............................••--- (Complete in Triplicate) f ................. Date Issued ...�'.�y`.'.:.�.. r This Permit Expires ]__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. JOB ADDRESS/LO kTION � ....... .tea :5P-c..e�r._1 - � .........................CENSUS TRACT Owner's Name �_.....`C?�-...................................................Phone . k .................... � -•--•-........ City Address .... ..._._....._.__:...... :................... .y_... Contractor's Name ........ ......License # � ` .. Phone . � •' 'c�f I Installation will serve: Residence Apartment House Commercial ❑Trailer Court 0 Motel ❑Other ...-_-------•------------------------------- Number of living units:__.,:'.._._. Number of bedrooms -••___Garbage Grinder ...._____... Lot Size ..t-' ---�:{•` -••----- E Water Supply: Public System and name ------_- _...... __ .....................................Private! Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ ' Peat0 Sandy Loam {] Clay Loam 0 ► type .-! -- Hardpan ❑ Adobe [�, Fill Material ._.._.....-_ If yes, typ - - 1 l 1 I (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,] ( PACKAGE TREATMENT ( ] SEPTIC TANK ] Size.............w_....... ....---•......__...__.._ Liquid Depth __........._..........-_._.� Capacity` Material...................... No. Compartments •_--........•.......-- Distance to nearest: Well __.•_..Foundation __ Prop. Line ..........:...........00 . Length of each line._._.. •------- Total Length .......................... .. LEACHING LINE [ ] No. of Lines .................. . •- g ..--------•- D' Box Type Filter Material ................ Depth Filter Material '...,....... ................ Distance to nearest... ............:`'y--'... Foundation .. Property Line - ' . Rock Filled Yes No SEEPAGE PIT [ ] Depth ................. . Diameter ......=-----..... Number _._,_..-----:------ -_---- ❑ s f u f �•- t Water Table Depth J----••-----• ...........- .................Rock Size ...................... . ..... s ,o '1 I Distance to nearest: Well --------- ...... - Foundation,___--_..._......... Prop. Line ........ ••--.... ---- .......�.._ -7-:7.....- Date ... REPAIR/ADDITION(Prev. Sanitation Permit# -•-----J� -•• ` ry ' ......) l Septic Tank (Specify Requirements) --------------------•^-- ----•--- ••�r � 'j; , ,y,. ic.r Disposal Field (Specify Requirements) ......... . .. .. . .... a rr.t r --------- - #' -- ------------------- - ..• w... _.f (Draw existing and required 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, Slate Laws, and Rules and Regulations of the-San Joaquin Local`Heafth District. Nome owner or licen- sed agents signature certifies the following: ' "I certify that in the performance of the work for which this permit is issued; t shall not employ.any parson in such manner as to become subject to Workman's Compensation laws of California." Signed � _...-•-•............. .................. Owner /�,tda.l :..:............:` �'-...... Title ' ' B st ... .;...._. (If other than owner) � �� , FOR DEPARTMENT EASE NLY 1 -- ._.... DATE ... ='-� .S APPLICATION ACCEPTED BY :...----- BUILDING PERMIT ISSUED .. ---.... :...:.........DATE _.. ADDITIONAL COMMENTS ..- �. - w _ } -. . = . . Date . Final Inspection by: . . SAN JOAQU14 LOCAL HEALTH DISTRICT 1l 13 24 ,_ cfl D_ a�u► 7/72 3 M C