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I FOIZ OFFICE USE: APPLICATION FOR SANITATION PERMIT .......................... ..... .......... ............................. (Complete in Triplicate? Permit No. ,7. ..- .. .. Date Issued ---------- ----............................. --._..._--_-. This Permit Expires 1 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/LOCATION _..... .Z�l/.o .._. . }_ 4;?__.. ............_.......................CENSUS TRACT .......................... Owner's Name ..........- �L.�C.�._..d,;Xit+f �. °4IV-_... --------- ................................... . ?,� ..-------- --....Phone .... ... .. ..............`.�....._. Address .. 7Xc-f- J °+tis G.f -------------------- ------------ Cit .... Contractor's Name .. .... ...6.4 .R, 5 -- .- : .- -------------License # o�� ,'�_ Phone Installation will serve. Residence ftApartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ....... . ...............__---------_.- Number • •------•--•--•- Number of living units:.. . ._)'. - Number of bedrooms .- _.__-..Garbage Grinder _........... Lot Size 1!7 _. /4 2 � . Water Supply: Public System and name ------------------------------------ ....... ...........................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam.❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available within 200'feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-T� Size....... _ -3.. Liquid Depth ..-- ` -----_--•-- Capacity . ( ..... Type '' .._ Material............. } No, Com ariments - P �,................ I. R +4.. • , 00 Distance to nearest: Well fQQ...---------..._Foundation _.... ©........._ Prop. Line _.._................. LEACHING LINE[ ) No. of Lines Length of ach 'iine .... _ `!'.�,, _... Total Length ---/_9-------------, :D_Box .. .•3 Type Filter Material ..Depth Filter Material _....� _�:_._ --- . -- --------••----•------•- Distance to nearest: We11......r----_-. Foundation t4 - ......... Property line -----.______. SEEPAGE PIT, [ ] Depth {.._,. . ` Diameter ._...-_3.- � r _ No : , ` 1 . umer . -._-., ------ Rock Fiees Water Tablez�•- -... ..RockSize ----------- Distance �- to nearest: Well ......../.0.0.. ' .............:..Foundation Prop. line .. ........ 0 REPAIR/ADDITION(Prev. Sanitation Permit# -------- ..___......................... Date .........................._....... l Septic Tank (Specify Requirements) - - ......................... DisposalField (Specify Requirements) ......................................... --------------•-•-- •-• ...... ....._.. .... ...................................... - ................................................. ... . .................. .------------------------------------- ---- ._............-----..---•--...------ ------------------ . .. ................ ... ................... . ... ....... ----------------------- ............. --...._... ---•--......._.. ..... . .....------- ----------........ (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, State Laws, and Rules and Regulations of the San Joaquin Local Health 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, I shall not employ any person in such manner as to became subject to Wor an"s Compensation laws of California." Signed .... . ...--•-- • ------ Owner 8y . . . . - ------- -- - ----------....- Title �,,, . . --------------• other than owner) FOR D i TiMENT USE ONLY _ T APPLICATION ACCEPTED BY . _.._. .. ................. DATE . d :. ..--- BUILDING PERMIT ISSUED ......... ..... .... .DATE . ---- ................ ADDITIONAL COMMENTS .... -------- ---------.................... ................................ ..................................... 6Final Inspection by: ...... -- ... - --- Date ..... .__1� .. -J._ .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/72314