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FOR OFFICE USE: 1 APPLICATION FOR SANITATION PERMIT ' �................ Permit No. a (Complete in Triplicate) I ............. ...--_-___-..-------.-.- 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB -ADDRESS/LOCA T -) _5 r� ..-- ..... ........... _,::',Ci SUS TRACT .......................... I Owner's Name -...... ... ......_......... .......Phone�-..........�................... �,�7 Address -•S--7 r2_. C..i..._ City .:. ..... ..........:.:...._................................ . � - 1 Contractor's Name ..�-w�c.' '... Ut__: , cc._ Phone ................... i ...... License # Installation will serve: Residence [!rApartment House[] Commercial -OTratler Court 0 I Motel ❑ Other..' •-- •------ ........ Number of living units ...... Number of bedrooms _._�....Garbage Grinder .._........ Lot Size ..., Water Supply: Public System and name .................:...:..... .............. ---.............._............._.._....._. Private Character of soil to a depth of 3 feet: Sand 0 Silt ❑ . Cloy' ❑ Peat ❑ . Sandy loam 0 Clay Loam j:] :W Hardpan [ Adobe Fill Material ........ _... If yes, type................... j (Plot plan, showing size of lot, location of syste_in_re�ation. 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 f ] Size ................ ................................. Liquid Depth ...................:. ` } Capacity .................... Type .................... Material.......---••--------- No. Compartments ...._...-............� it Distance to nearest: Well .............................:......foundation ....._._.._........... Prop. Line ........... LEACHING LINE [ ] No. of Lines ......__................Length of each line ............................. Total 'Length ..................,.._.--_,.. r D' Sox Type Filter Material ; .--_-Depth Filter Material ........ :----------------------------------- - Distance-to nearest: Well ...... ::............... :. Foundation ... Property Line SEEPAGE PIT [) Depth Diameter-. ................ Number ..... ...........---------- - Rock Filled Yes [] , No � { Water Table Depth __. Rock Size -- ... 7 f ................ S Distance to nearest: Well ...... ....._....._... Foundation .................... Prop. line ................_....{o REPAIR ADDITION Prev. Sanitation Permit # ------------_------------- Date ................ 1 Septic Tank (Specify Requirements) .................... -•-_--•---•---_-----.-...--T................. ........... ............ ,................ .-----..... Disposal Field (Specify Requirements) ...... ~t - t' f- � ••• ! �` --• �` "` ` • "---_---_ i ?a. .......... c7.. �a _rf.JS.__ z...t".---...-..».:...................................................:...................................... Vic.............. ....:.... I (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 ae.ordance with San 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 fallowing. "I certify that in the performance of the worn for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California."' Signed......... __------------ :............:..1.......-................ .._. Owner B.......................... tle _ _ --.-. .._-:.._..................... 2 .`mss — 6- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ......... . ... t DATE ...7.5.`-..._-- BUILDING PERMIT ISSUED ..... ........ ........ •-.-..-.:....-- -.- DATE DATE....... ADDITIONAL ADDITIONAL COMMENTS .._.x�--....-- •---•.....................• ....---•-•---•-............---••.._...- _....._ .._...._....... .,� ......................... •-•---------------•.............. ............................._...........................-----.............................----..........................................- .. ................................................ .. ...................................... �...... FinalInspection by:_................ Crl.................. ,..............:......---...----..........::......_......_.............. Date rd . .. 5.............,. SAN JOAQUIN -L OCAL HEALTH DISTRICT _ E. H.13 24 1-'68 Rev. 5M 7/72 3 hi