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FOR OFFICESE: APPLICATION FOR SANITATION PERMIT ...... ......................................._.--. iComplete in Triplicate} Permit No. - -.._..._.... ............................................. Date Issued -97-7.-;)-7-..7S... .. - .... •••"•-..--"""-._-"" .................._-.._•- , This Permit Expires 1 Year From Date Issued Application is hereby made to the Son 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: � \ -•-••-- "_--._...CENSUS TRACT ... ; ::.. JOB ADDRESS/LOCATION --QM � Owner's Name . ................ Qn re.. ---d�------- ..__. .................. .. city ... Phone A Address :, �� Contractor's Name .. =. .......... ............ .-- .•-------- ------License # .`..:::_..:. .......... Phone -----;.---------....---------- Installation -• - - Installation will serve: Residence X Apartment House f❑ Commerciol-]Trailer Court 0 f Motel ❑ Other.... ....:.......:.:::. } i jj Number of living units:.:..1.,_..,.. Number of bedrooms .. ------Garbage.Grinder:...._..._....:i.ot Size....__............ ..................... 1... Water Supply: Public System and name % ..:.......:.... ------ Priv i Silt CI ate ❑ Character of soil to a depth of 3 feet: Sand S' ❑ y ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ ' iFiardpan [) Adobe ❑ NI Mt -terial�� If yes, type -• -•-�-.- . -- ,� { (Plot,plan, showing size of lot, location of system in .relation.to wells, .buildings,`.etc,'. most be placed on reverse side.) WEW INSTALLATION: (No septic tank or,seepage pit'permitted if public sewer is available within.200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK,j ] ; Size.--- ...... :_ Liquid Depth ........... ._.3..� Capacity :-...- Type Material..;-.- No Compartments' .._............- Distance to nearest: Well, _"_._..."Foundation -- ". •-•---..._-. Prop. Line ..................t_ ; LEACHING LINE [ ] ;_ . . .. g h of eath line ; .... Total length No. of Lines'. Len t YP Filter Mate�iaf } ............, D Box .: T e Filter Material ._ -Pro - - - -Depth ---------------- Distance .�_ SEEPAGE PIT ' Depth: to nearest: ameter __ .-------- Number Rotk Filledin Y ( l P . • es ❑ No Water.Table Depth _...- ----------•--=._.....: --- a ...-- Rock Size Distance to nearest: Well ......_,_ - ---- '„_..;..,---`._._Foundn _atio :-:_.,,.;;. ..,_ p ine -- ._ . � is : -- ) !� REP IR DDITION(Prev. Sanitation Permit# Date _ ro i -- - 4 } ptic Tank (SpecifyRequirements) _ _.r- - .-- Disposal Field (Specify: Requirements) ---96'.- - --- . -- _.... .... ----------- --- ----_. ........ . _ _ ......................... ............ .............. ..-.".._..................-...._------- .-._..........._._--........--... ...---...._.........._....----.------- (Draw existing and required addition on reverse side) , 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 Healeh District: Home owner or licen- sed agents signature certifies the following: i "I certify that .in the performance of the work for which this permit is issued, I shall not employ any person iniiuch manner as to become subject to Workman's compensation laws of California." Signed _ ----------------=--------- Owner 6 0 By . - ............... Title ................. .......... : .._.._......------- (if ootiT er than owner) , ��_.._—__ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .._. . . , ._.._ ... ..............: - DATE ...�-...1�.._.. _ ADDITIONAL OIMMENTSD.............. '-- .....------.....-----• DATE - ------------ BUILDING .._.i. .......... ................. ..... -------- ---------------- ---------------------- ....--- ......--- k --------------------------------- -r...- -- - ....... .......... .... •--- _....... --- - ............... . . •- -- .----•-. a f ............ __-- .-- FinalInspection by: .': .. ......................---••----..._..------ - .:----- ..._.:......--------.._Date ---.....--1--...._......__.. ....-- --••-- SAN JOAQUIN_LOCAL HEALTH DISTRICT e u 13 24, -,ko o_.. cr<A 7/72 3 M