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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT ............. ....�,.{ --..-....---�..-..-.... -. Permit No. 7�r._T:�'•s (Complete in Triplicate) ..............................•.......................... ---•..................................................... This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 egulations:JOB ADDRESS/LOCATION ../a..5.?,,,?.... Dltl.Cr� .5/ �..:.��1.�.......::..........CENSUS TRACT ........ Owner's Name ... 'lw.�r .... ....................•---.- ---•,-----------------......---...........Phone ..-................................. Address ........ --............................................................................ city .,.5�'ll�Y'!��`d� Contractor's Name .. '.-• j ` '.. .--.c ...............License #�7.78�.3._.. Phone Installation will serve. Residence 9kApartment House 0 Commercial OTrailer Court,Q Motel ❑Other ............................................ r Number of living units:...- ----- Number of bedrooms ... ....Garbage Grinder IVO Lot 5iz / - "=.-----. Water Supply: Public System and name ---------•...............••------•-..-•--------._.._................------------...........:...,...............Private Er Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe.0_ 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 j Size...................................._--------- Liquid Depth ...........................O Capacity --------------_--- Type ---------------•---- Material--------- --•--•---_ No. Compartments ---...................0 Distance to nearest: Well ....................w._...............Foundation .------............_ Prop. Line ...................._.V! LEACHING LINE ( ) No, of Lines ________________________ Length of each line------------------ ------. Total Length ............................ W 'D' Box ........ _-- Type Filter Material ......•.............Depth Filter Material ..... ... ...........:............... Distance to nearest: Well ........................ Foundation --_-_--_-__...-...___._. Property Line :.__.__......_.. F SEEPAGE PIT ( j Depth ..........:......... Diameter _............... Number ------.----..-..---..----.-. Rock Filled. Yes ❑ No C]f • Water Table Depth ..Rock Size to Distance to nearest: Well ........................................Foundation .................... Prop. Line REPAIR/ADDITION Wrev. Sanitation Permit# ........... .......... Date .................................. SepticTank (Specify Requirements) ----------_------ -•------ ...........................................................................................------------------ Disposal Field (Specify Requirements) --..--- - -go---0.G�.._,0411Y�. 9Q-- ................... ........................ .••-•-----------•--------------------------------------------------•---........ .---......... ........................ M - ---- -- - - - - - ------------- - - .............- Draw existing and required addition on reverse side) 1 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 as to become subject to Workman's Compensation laws of California." Signed .....................-............. ....... ......... . -------- ---------- &----------- Owner s BY ............................................. • -'----: -- - --- ------ ------------------------ title ....L�p /.. .c ................... (if other than o er) _ FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY ._ DATE _172-k...Z..�_1..._.. BUILDING PERMIT.ISSUED ---------------•-• ------•-•••---------•--------------------------•------....-•-•---•---•--------••-----.-DATE ................................. .. ADDITIONAL COMMENTS ...................... .................................. •--•------- ........---------------------------------------•-------- -- ....................................... . --....... ----•----- ----- - ----- Final Inspection by: Date ..�..-�:-.�1. ..7 .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1-'68 Rev. 5M 7/723 M