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FOR OFFICE: USE: APPLICATION FOR SANITATION PERMIT ....................................... . ...._....__.... . (Complete in Triplicate) Permit No. This.Permit\!Ii4res 1 Year From Date Issued' Date Ensued Application is hereby made to then Joaquin Local Health District for a permit to construct and install the work herein described. This application is mad in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _s?t__ =', --,--•% .-�.. � ./�C�._...._.� _%...CENSUS TRACE" S rEf..J........._.•.- Owner's Name .... ":./i...._ `"O. .. - 7. ................... ...... ........................... ...........-Phone .............................-...... AddressQ Contractor's Name .... f �! � .-------..........................License # 1.�...�.��_ Phone Installation will serve: Residence ❑Apartment House Commercial { )Trailerf;WW // Mote! ❑Other ............................................ 1 fr _ Number of living units..--/--_- Number of bedrooms _--.-__Garbage Grinder .tIlK Lot Size ................ Water Supply: Public System and name .---•--------------------...............-------•--------------------------------------------------------------Private Character of soil to a depth of 3 feet. Sand•❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy Loam ❑ Hardpan ❑ . Adobe JZ Fill Material --_-------- If yes,type ............................ (Plot plan, showing size_ of lot, location of. system in. relation .to_►elIs,.bj!i1di.ngs, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) f PACKAGE TREATMENT ( ] SEPTIC TANK Si e... __. ... _�`4-.. ................. Li uid De th � q P -7. Capacity�,i? �_..._ TYpe ,f'. Material al.� L�'l�._. No. Compartments .fir_.......... 00 Distance to nearest: Wel( . ...Foundation ./ ..__..___-. Prop. line ._ LEACHING LINE 1 No, of`Lines .......1--------- .... Length of each line. ...... Total Length .,....... `) D' Box _/ ._ Type Filter Material ....Filter Material ._��...�................. ........ Distance to nearest: Well __...�� .�_...•_. Foundation_:.2+�.....- Property Line .�--- SEEPAGE PET (t,� y Depth ....- ( ,,� _________________ Rock FElled Yes No [( d••-_•__. Diameter'.. Number _.. .. th Water Table De Distance to nearest: Well r� ......... ' -- . ..._= Rock Si �,� ::::.:.............. ze /.-.:�- ...... a --_--� ._. :. � .....__.._.Foundation -_-�.�.�.... Prop. Line ... ...-_-- REPAIR/ADDITION(Prev. Sanitation Permit!# Q ............................................ Date .................................. Septic Tank (Specify Requirements) ......................................... ' Disposal Field (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 become subject to Workman's Compensation laws of California." Signed ........................ ... ............. Owner By ................. ............... ....... .................... Yitle --- 1 1._ .................................. (If oth an owner) N, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ...................•-•••-•-••---••-••--•-----_.... DATE S .s9'"T•J...._...._.... BUILDINGPERMIT ISSUED ................................................. .........................................:....... •--•-._DATE -- •-------•--••--•-----•--•••----------• ADDITIONAL COMMENTS -•...........................•-------........._.......--- -- - :....--•••-•• -....---•-------------------•-----------------------------------------.--.--.---•---•------------•--•-------------------------- ------------------------------------ FinalInspection by. . -- -- ---- A -----•----------------•-.......-----•....._............_•......_••--_.Date ..�... . ..................... SAN JOAQUIN .LOCAL HEALTH DISTRICT H.13 24 1_'68 Rev. 5M7/72 3 4