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FOR OFFICE USE- ... APPLICATION FOR SANITATION PE$MiT -- �---. . 7 _yes (Complete in Triplicate) Permit No. . __. ...__ . ----. This Permit Expires 1 Year From Date Issued Dote Issued .. ..-.7.-:7 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 madeincompliance with County Ordinance No. 649 and existing Rules and Regulations: JOB ADDRESS/LOCATION .✓..... /v .. ._ .¢.Grp ` ............ ......CEIVSU5 TRACT -....5'. �. Owner's Name ............ t-----Al --•--••..........................r....-•-- •---................Phone Address l.a.� 1 I&ILk-v-------------------------------------- ------------- Cit, ../V/,ff TG -----.�.5. �r7S!GC...----- Contractor's Name ---.-A. ---------------..................... ...'License # �-�ss� -- Prone Installation will serve: Residence &Apartment House❑ Commercial❑Trailer Court 0 Motel (]Other .................... ------•-•----- -------- Number of living units:.... ------ Number of bedrooms ..2-...Garbage Grinder NO---- Lot Size ........67C-F` .....,.....-- Water Supply: Public System and name ... ..............-........................................................•...........-----------Private [� Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ PeatSandy Loam Clay loom ❑ Hardpan ❑ Adobe ❑ Fill Material .. ..r(}.-.._ If yes,type .................... (Plot plan, showing size of lot, location ofsystem 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 I ] Size....................--.................... ... Liquid Depth ........................_. .. Capacity ...--------- Type . .................. Material.-----------.......... o. Compartments .............. )+ Distance to nearest: Well .......................Foundation ....... ............. Prop. Line ---................... L'1 LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................ Total Length --------------------------- 'D' Box ............ Type Filter aterial ....................Depth Filter Ma rial ----------.._..............I............... Distance to nearest: Well .... .................. Foundation ........... ....... .. Property Line ............___-._.....- SEEPAGE PIT [ l Depth .................... Diamet r ................ Number ....--------- Rock F' Yes ❑ No • Water Table Depth ....Rock Size Distance to nearest: Well ..... ................................Foundation ._.... ........... Prop. Line ......._.. ...... REPAIR/ADDITION(Prev. Sanitation Permit# ...._........ ............ .... Date ................... - ) Septic Tank (Specify Requirements) ....... •-------t -- ••. --•---•----.....--------------------------- % a + Disposal Field (Specify Requirements) ....:rt?�TJ 4.T...GLN4=.........SV--------rpla .—....W .L�--.....--.--b---------- o. ...-.......9.0........ ------------------ --------------- --------------------------------------------------------------------------------------------.-..................--------------------------------------------------...._-----. (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. Mont* owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this pertnit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ......... ...4.t..../.--v ZZ107A-_-............................................. Owner ' By ............................................ ------------------------ Xitle . ..... ......................... ................. ----------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... -o-----------------------•------------------ ......................... ---------- DATE ....... ©....73...... BUILDING PERMIT ISSUED ......-•..... ----------- --------------DATE . ..-----................_........... ADDITIONAL COMMENTS ----------------•----------------------.- - - --....--•-•- -•----•=---•----••-- ............._.. :..._....._.. �............ ..•- -- :... ------------------ .. _.--_- -- Final Inspection b •• - --... -- -- •" ------••--- -- -=---------.—Dote —, ••--•---Date . ' --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. fi. .13 24 1--68 Rev. 5AA 7/72 -M