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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..•.. This Permit Expires i 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/LOCATION�.. .`,.,L - A...... - ._.... . CENSUS TRACT ......... Owner's Name ...._....._ .... Q`-d..L� � � hone ... Address /. .... ....2'1 �.. .. _ City .................................. Contractor's Name .� –.. ..License #ozc, yl�y .l... .'I. _ . Phone . Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court fl Motel ❑Other Number of living units: . ,�.. . Number of bedrooms ...��._-__Garbo a Grinder _... g `�+�' Lot Size ..fa ��- -��-:�'_...... Water Supply: Public System and name ...._ _. ..,/rt,tt-C .--Gt1..�-c•c_ ----------....-------------------------------------Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan '�'l Adobe ❑ Fill Material .... If yes, type . ._....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, et;. 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 TAMC��` Size..�,P 1,��•fs�fQ f, liquid Depth ..47..e Capacity`- /o6,4YPe Material_ No. Compartments -�f .. .. ._--_. Distance .� to nearest: Well J� -. -----------------Fov'ndation ..../1.l. �....... Prop. Line _. ........ W LEACHING LINE [ ' No. of Lines ,r N Len #h of each line . S _ _.... ._ Tota! length _.��.__�•%_....__._. 'D' Box .. .� Type Filter Material 16I-40t .....Depth Filter Material,... , .fP -._ ..�-_•-•„---;_r Distance to nearest: Well ...� _r........ Foundation / ..r..._..._.. Property Line _4.__.f. SEEPAGE PIT Depth Diameter - ----- Number ?. .......... .. Rock Filled Yes J No Water Table Depth _..---•� -------------- ---------------Rock Size ...:�..__...._ 4fJl Distance to nearest: Well .. Jr.. .......-_ . Foundation .... d_r Prop. Line REPAIR/ADDITION IPrev. Sanitation Permit# -------- ---------------------- - Date -'---.----------.- ) Septic Tank (Specify Requirements) ----- ---- -----_------.._...-.------ Disposal Field (Specify Requirements) --------------------------------------------- ----....- { . ...... ........ --...._. .... --- ..._..------........................... (Dra'w existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be den* in accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Horne 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 /�r --'�—:_.. Title (If other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . DATE ... y-��.� 5�......•---....._.. BUILDING PERMIT ISSUED .-.. .._.. . ---- .......DATE . tom,. .... ......... .... --� -- ...._... .. .....-.----....._........ ADDITIONAL COMMENTS ..3! /. 7J.`._ .G1- .............. ..................... ....... ... . ...............____.......................... Final .............................. l!� Inspection by: L�f . - s- -------------------------------- -- Date ... .. f/ �.�.... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13. 24 1.'68 Rev. 5M _ 7177 1