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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT - - - _ Permit No.(O (Complete in Triplicate) q FDate Issued - This Permit Expires 1 Year From bate Issued Application is hereby made to the Son 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 __ ___-- G -- ---- --------------- -- CENSUS TRACT --- -- Owner's Name _.-------------- __----- - - ----------- - -.Phone --�-- •- Address .- - ----------- � - Cit Y� ?WL-h Contractor's Name ------------ � ---------. --- one W67 k Installation will serve: rResidence-O(Apartment House❑ Commercial []Trailer Court ,❑ yy� Motell❑OtMer• ----_I-------------------I- i / -- -------- - Number of living units:--.-f---j—NO—Mbe�o a rooms r ,�,yr��,,, �} / r -Garbage Grinde .�(�1_ _� Lot Size -- 0__X//0 _ - Water Supply: Public System and name tt; --------"` 4 14 ----- - Private ❑ Character of soil to a depth of 3 feet: Sand-El Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ q4 Hardpan [�T dobe0y Fill Material --_-.------- If yes, type ---------------------------- w, i (Plot plan, showing size of lot, location of system in .elation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is avail-oble within 200 feet,) PACKAGE TREATMENT [ 7 SEPTIC TANK4-�� '� � Size------------------1r;_�--� �----- �`s: Liquid Depth --------------------------- � Capacity -------------------- Type --------- der ial l - -- No. Compartments Distance to nearest: Well - �P�#___-__Foundafiibn ---- _-____-_--- Prop. Line -_------------------- LEACHING LINE [ ] No. of Lines ------------------ ___-- ttij _ Total Length I IT 'D' line________ __________� - ---------------------------- Q' Box ---_.- Type Filtl Material --------Depth Filter Material --------------------- ---------------- Distance - ----- 1 i . .-. a .i r- Distance to nearest: Well __-- nda Iota -------------------- -- Property Line n SEEPAGE PIT [ ] Depth11 0-------------------- Diameter-------_._ tuber -------------I---------- Rock Filled Yes ElNo 0Water .Table.epth ___- -— ----- ---__ Rock Size .-_ ----------------------- Distance to nearest: Well -------------------------------- ------Foundation -----.------------- Prop. Line ---.-•---____ -------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------- pate ---------------- Septic Tank (Specify Requirements) ---------------- Disposal Field (Specify Requir ents) --- --------- ------------ ---��--' ._1-_4... I r ----------------------------------------- -.___'---------_-__--------------- __--____._ -- -__-,--_ *--" {Qraw� existing and required addition on rete :44 sidle) I hereby certify that I have prepared this application and that the ork will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin LocalHealth District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit isissued, 1 shalt n t employ any person in such manner as to become subject to Workman's Compensation laws of � FiC}}ffa,,liforn ia Signed ------------------- .' r -Owner- -- ------ BY T th ------ --'- .,. ------------------------------ (if of ecR!l61)ARTE� eJSE ONLY APPLICATION ACCEPTED BY DATE Z BUILDING PERMIT ISSUED _ ____ _ _________ - DATE ADDITIONAL COMMENTS -------------------------------- ---- ------------------------------------------------------------------- ------ -------- ------------------------------------ Inspection bY p Date Final Ins SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M