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FOR OFFICE USE: R SANITATION PERMIT _ APPLICATION FOR 3 rc,�6 Permit No. . _ ...... .................. ..... (Complete in Triplicate) ................................. p .................... Date issued .�'n?5..7..... ................................................... This Permit Expires ] Year From Date Issued Applicationis 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: I JOB ADDRESS/LOCATION I t ��. .4` E /11.X411f---Q .�..�? �4J �.(�a .. EN5U5 TRACT .... ........ . ....: Owner's Name ......, . dq. .......1`7�. .E.L!>_.-�0.7 1ti... .> s... ..........•------ ................. Phone . ..I..... Address .....:-...-c . 5.` - ...- t�E ? .Po ! ...[� .:........... ... city .... !.1Z(VV.........I............................ Contractor's Name ... ..') - -IS. �-.l-. f � -........_.License # � .� . Phone Vi i..... . . ... i installation will serve: Residence Apartment-House Commercial❑Trailer Court 0 Motel ❑Other ........................................... Number of living units:..-1........ Number of bedrooms ....Garbage Grinder ............ Lot Size ...... •�.p..� . Water Supply: Public System and name ................... _. ..........---•------ •--------•....................................Private Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peau❑F"Sandy Loam ❑ 'Cloy Loam - -b ..-: . _ - - _.. - 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 avtiilable Within 200 feet,)' s Liquid +Depth .... PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size............................. :: Capacity .................... Type.... ..,,_:.......... Material...................... No. Compartments ........... Distance to nearest: Weil - _- ...........Foundation ..... Prop. Line 9 LEACHING LINE [ ] No. of Lines ngth ofteach line......................... .. Total Length ............................ 'D' Box ............. Type Filter terial ....................Depth Filter Material ............................................. . Distance to nearest: Well ................ Foundation -------........... ..... Property Line ......................... Rock Filled Yes No A SEEPAGE PIT [ ] Depth .........:.:........ Diamete ................ Number ....................... .. .. ❑ ❑ �s f Water Table Depth ........................Rock Size .....-- .... I Distance to nearest: Well .!.Foundation Prop Line ................... . .� . i° Date .........................• I REPAIR/ADDITION(Prev. Sanitation Permit# ............. .I........._ _•-•--.. Septic Tank (Specify Requirements) ............................ .................�..........--•---......................--•--...------ ... .. i• ...._................. f r Disposal Field (Specify Requirements) ----4AA... �.QC�.. - 4-�Z.--. -'."'. -7� --K.Q.S.-....'. T............ ....................................................................................................................................................................................- ...................... ........................................... .................................::::=_......::..:.-:.:....:.............. ......... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work w1il;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: ` ' r n ' �• "I certify that in the performance of the work for which this permit is Issued;I shall -not employ anj person in such manner as to become subject to Workman's Compensation laws of California." Signed .---....... -•................. .t...... ... --•--... ........................ Owner By . ........................ .Title ......-....-. .......................... {I other t owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTf:D BY .. DATE ..... �..r....................... 1 .. .......,. ................•----..... BUILDING PERMIT ISSUED ..................DATE ............................----........... fADDITIONAL COMMENTS ••..........................................•.............I...............I..................................:...........................I....... .............................. ... :. .............Date .. ., w..' !t . Final Ins l SAN. JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 M