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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7��j._....�� .......... ...... ..........................•�- .- - (Complete in Triplicate) Permit No. ...,.... .. This Permit Expires 1 Year From Date Issued Date Issued -�1~._...�y 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 wit County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . .... _�. .G..� -.--- - - ------- ....,1�(�.. �................CENSUS TRACT ...................... Owner's Nome ....... . �I ... .�.` ..... -----------Phone ...�I/I:�.� ..... - a Address ..... . � 'f /ctF .r------------------ City . / Contractor's Name .-MZZ.'c.Ct -. ---------------License #;Z41.71.7.1._ Phone IXIK 7.7.01 Installation will serve: Residence r'Apartment House 0 Commercial OTrdiler Court 0 Motel ❑ Other ...... ............ ----------------- Number of living units:.. _ . . Number of b drooms ......Garbage Grinder .. lot Size .. _ _t= -...........-q4 L Wafter Supply: Public System and name ....A&�* ;,�---•-- ..........................................._......_.PrivateA Character of soil too depth of 3 feet Sand.❑Silt _YClay ❑ _ Peat[-].❑ Sandy Loom ❑ Clay loam HardpanX Adobe ❑ 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 ] XIS iz ------ --------- -- ----------- ----- Liquid Depth .......................... Capacity . - Type ..... ............._ Material........ .. ...... No. Compartments ----..-----_..._._--_ Distance to nearest: Well Foundation .............. ....... Prop. Line -_-------------...... LEACHING LINE Na. of Lines / Length of each. line .lei. ... . . Total Length '.�........_.. r 'D' Box '.:;P- Type Filter Material 166 ...-..Depth Filter Materia! .. ...............------.......... Distance to nearest: Well _-S . Foundation ......... Property Line .. _. .......... SEEPAGE PIT Depth Diameter _�~'t .`.�.- Number . ... .. .............. Rock Filled YesNo (] Water Table Depth --._---jC --1-11.--•- •-•----- ---------Rock Size ...... ................ Distance to nearest: Well ................Foundation _A�. ....... Prop. Line ...... REPAIR/ADDITION(Prev, Sanitation Permit# ........ ............. ........ ............ Date ---------.-_.____.....___-___.__:.) Septic Tank (Specify Requirements) .. _------- -- ---- -..... Disposal Field (Specify Requirements} *- .(�' -,- - C��r. ......... ... ._... .. -- ------........----.......--'--...-.....---......_.................... .... . ........................... ----_... (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, Home 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 V as to become subject to Workman's Compensation laws of California." Signed . .. . .. - Owner Title By (If other than owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ... DATE BUILDING PERMIT ISSUED ....- - DATE -- ADDITIONAL COMMENTS .... . ` - . -... 1/L ,� ------------------------------ .........-• -- .. ------•----------- ----------......--- -- ----------------..-----...-----• ••--------------------- -------......------.._... ----. Final Inspection by: ---....-•.................. -------- .....----. --• . .............Date __. _/.. - 7... _... SAN JOAQUIN LOCAL HEALTH DISTRICT i13 24 ' E..H. 1-'68 Rev.. 5M _ 7/72 3 .H_—_-