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.0 FOR OFFICE JUS.USE: APPLICATION FOR SANITATION PERMIT 70 Permit Ne. ..7. 1 Y (Complete In Triplicate) ' ' .iJ.-- ....................... .................................................. This Permit Expires 1 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 mad6 in tompliance with County Ordinance No. 544 and existing Rules and Regulations: r JOB ADDRESS/LOCATION .... ,� .. .� .. ..................... ENSUS TRACT .........................i Owner's Name ./��/y�.. , Ir. ........ . ,.. ...... M -- �hw...Phbne ...Y�� ........................ Address _.�1 ?t•-C .. •----..... City - 1 : 1 4 "Ot Contractor's Name +' i9.A1L _-.-._ :...-- -:_--=:License # -- . - Phone Installation will serve: Residence 0 Apartment Ho6se0 Co erciol ❑`railer Court'o Motel' Other ... Number of livingunits•.. Number of.;be-drooms . arbage Grinder. ...........L. t Size _..,.�h..... . ...�...._-- _-� - .... Water Supply: Public System and name, .._...._:_.___ ---:-_.-. . r � . . ---.-- ..Private ❑ Character of soil to a depth of 3 feet: Sand El : Silt p- Cl :❑ Petit❑ Sandy Loam ❑ Clay Loam ❑ t Hardpan ❑ Adobe [ Fill Ma teribl _ If yes, type. . (Plot plan, showing size.of..lot,..I:oSatio».of. system'.In,relation. to.wells, b.uildings,..etc. .inust.be..plated on tever'se. sideJ NEW INSTALLATION: (No septic tank,or seepage pit permitted if public,sewer is available within 200 feet,) s PACKAGE TREATMENT [ ] SEPTIC TANK [ Size .. ... !Liquid Depth .. ... ..... ...... ' Material .. No. CoparmentsCapacity .... Type:.. ... ... t Distance to nearest: Well `.---...:..... ............. ...... .Foundation..................._ . Prop. Line ................ LEACHING LINE No: of Lines ---------------- Length: of cacti iine....:......:....._�..._._. Total Length = g ---- ° D' Bo)( T e Filter lNaterlal' :_.:Depth Filter Mbterlol Yp d -- :_... .. Distance to?necirest: Weil ........ ..... ........ ... .Founddtion; -----_--•- ....{. .. `.Property Lihe .. i SEEPAGE PIT [ J Depth L....::....:.:: Number _-- '-=--�.' -Diameter. .....''Rock--Filled >Yes: No (j', Water Table Depth....... ........... .Rock Size ...:--- .. .. ., I Distance to nearest: Well .....:.....:.Foundation Prop. Line . - REPAIR/ADDITION{Prey. Sanitation hermit#. .. ........... pate .. ... ;-1 ... ..........:. Septic Tank (Specify Requirements) ...:____ l •- --- ............yr � Disposal Field (Sp cify Requirementsl ------ �_ ...f.... T f+�t� t . i ....... yC . ----- - ------- {Draw ex ting affil 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' Jociq ulna County'Ordinances; State Laths; and Rule's 'arid'Regulations of'tile San Joaquin local Health tor 11cew ; sed agents signature certifies.the following:.: ..... .., ...:: ... :.......:.......'.. ... ..,. .. .. .... "I certify that in the performance of,the work for which this pernfit It issued,A shbll not employ anya rson in such mann, r as:to become sub' 'Workrriaii's Com ation laws of California. SignedAnerl Y ;_ . .. ..6 ..... ......... , - - --- - --.,. .. ... .- title -(If other than FOR DEPARTMiNy-. USE ONLY: c APPLICATION ACCEPTED BY ...:...... .. :. BUILDING PERMIT ISSUED : : . .. .. . . - ADDITIONAL COMMENTS .................... 1 - - .. ....,�... .............. .................._.-...-_. ..,_.._... ........_-.... - - - - ........................... ...... ...... --------- ............. ......... .......... .... . . .. ......... .. ..... ..... _� .. __ .. ._ ... ... Final Inspection b .... Date �. .c.. 111 J AQUIN LOCAL HNEALTH; DISTRICT _. z. _ ._ _ �_. J + E. H.1.3 24 1-'68 Rev. 5M 7/723 114