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FOR OFFICE USE: " /`'`APPLICATION FOR SANITATION PERMIT lContplati In Tsiplicata) ..................<......_...:......._..................... This Permit Expires t Year from Date Issued Date Issued�.r..�- 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 ...S7 ........;.•��.."m - +�, G .......CENSUS TRACT Owner's Name ....... ........... _Q i. C... . ....-• ..Phone � :.. .zr�d...... Address .................... p"r�. � ................. Contractor's Name .................. . `... u ...............Lieenseo�►S`}:3`7�3............ � c�6 0 "7 Phone ........ . .... Installation will serve: Residence Apartment House 0 Commercial oTraller Court C] / Motel [:1 Other............................................ / Number of living units:......i_._.. Number of bedrooms ...._?......Garbage Grinder ............ /43 ---.._... Lot Size � ................X..........---............ Water Supply: Public System and name __ --- ................ .... -..........?..�:.! ...........................Private Q Character of Boll to a depth of 3 feet: Sand 0 Silt j3 Gay ❑ Peat d Sandy Loam Q Clay Loam ❑ . Hardpan❑ Adobe t9 Fill Moterlol ... ........ If yes,type ............... ............ (Plot pian, 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 � ' � .If.......• E J Slze..........1.�.... Liquid Depth }J Capacity l .. ._ Type ......... No. Compartments p ......................N Distance to nearest: Well ................................._..Foundation ....A)............ Prop. Line ....!E`.......... LEACHING LINE 14 No. of Lines -------1--------------- length of each line........ .5............. Total Length ...(fv_. ..... V Box p " _........... Type Filter Material ..............Depth .Filter Material ...-Z Do stance to nearest: Well ........................ Foundation .../.o................. Property Line -;F 1P SEEPAGE PIT �(j I,` Depth .... .---•_... Diameter ..�.�$ -_----- Number ......../.�....,��... .Pock Flied Yes No Q Water Table Depth ................................................Rock Size .� ............ .......... Distance to nearest: Well ............................... --....Foundation ...AZ r:....... Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit ...................... Date ................... Septic Tank (Specify Requirements)....... .............. ..............------..... Disposal Field (Specify Requirements) ............------------------------------•...._.....-••---•----... ....------•••.......... 1......... . -----•-•----------------- ---------------------------------------- .........................-..:-----••------....--•---•---._... (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. Homo owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work far 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 BY ` ) Title (ff other n owner �� -- ---------------------- ........................... FOR DEPARTMENT LISE ONLY APPLICATION ACCEPTED BY ...... __.- --_.. DATE 7,:�:--_- BUILDING PERMIT ISSUED .......................................... . . DATE ........................................... ADDITIONAL COMMENTS --------------- ---- •---------------------------- -----------.--------------- ................ -------------- ...-•---•.... --- --•--------- _ •----•-•---- ................ •............................ .... ------------------------------------------------ ................ ------ .............................. Final Inspection by: -------------------------...................... ---------------- Date ... EH 13 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M .wy •-