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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 4........ ; . ............ ........................ Permit (Complete in Triplicate) -- -------- ------------------------------------------------ � �. Date Issued --7�,�1' ...•........... This Permit Expires 1 Year From 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 made in compliance with County Ordinance No, 549 and existing Rules and Regulations: � i f I.JOB ADDRESS/LOCATION :1 � / .-•-. f1 .'....:..::..-:.CEN5U5 TRACT ..... Owner's Name ..© _ --••-••.ICA -0I V.....-. ................ hone ..r��.... Address -.. `,lj� �. .... ........... ----•-----•---- •--.... City -�7�`�..-•--•••............---......... S ate. t i Contractor's Name .. /. ,E . .; -1 -••-cam. ��..--- ----------License # 17, Phone !�= Installation will serve: Residence IN Apartment House Commercial ❑Trailer Court D Motel ❑Other -------- ---------- ------------------------ r Number of living units-.-/-------- Number of bedrooms _.J......Garbage.Grincler N -_-_lot Size ,l�l�_��. - -_•- ........... y4 ` iWater Supply: Public System and name --.---------------•-----.......... _.... ---......Private ❑ 1 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan AdobeFill Material ............ If yes,type ---------------------------• (Plot plan, showing-size of lot, location system 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,) ` .. r PACKAGE TREATMENT E ] SEPTIC TANK..[ ] _ Size.................................•----- ........ Liquid Depth .......................... Capacity ..............-__..__ Type ......... .......... Material- _.____ No. Compartments ........... Distance to' nearest:--Well,....................................Foundation ----------------------- Prop. Line ......................[' r - -- LEACHING LINE . ( ] No. of Lines .........,..7-. Length of each line.---------------•---....---- Total Length ..- i 'D' Sox ........... Type Filter Material ....................Depth Filter Material -------`•,...--•......................... • Distance to nearest: Well ........................ Foundation ....-------.......-._ Pro a� Line ..........-------....... 3 I i SEEPAGE PIT Depth --------- Diameter _._.:_... ...... Number ---------------------------- Rock Filled Yes ❑ No (3 • Water Table Depth; ------------------------------------------------Rock Size •-----------..._ ........... Distance to-nearest. Well ........................................Foundation .................... Prop. Line .................. REPAIR/ADDITION(Prev.-Sanitation Permit ...................................... Dote ----------••-----•-•------------•-) 7 Septic Tank (Specify Requirerndr ts) ............/6Z -0....�--, jL-------•' ,cV •-••,/ 0Vements)Disposal Field (Specify Re uir :•-••_ --f-- .............:.. :.......................................... ..---• ------ ---------------------------------------- ................................................... -------------------------------------- ----------------- (Draw existing and required addition on reverse side) { 1 hereby certify'that 1,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 Iicen- sed agents sign6ture-certifies the following: : t "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 By .... ...:.......... . . ........... ........ �...... . Title .. .. (If other than owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----•-•--- ----------- -... _ _ �,.p. . ..... DATE ...7�'S.��Tr.�L...............-. f .........---DATE ........................................... i BUILDING PERMIT ISSUED .................................................................. . ADDITIONALCOMMENTS .............................:..................................................................... ............... ---..........._•-•......_ ................ i ........................................................................................ --------...---•-----•----------------------------•-------------•--•-----•------- .......•....................••--••••--•--.................• ......•.. -------------------------- --- -------------------....... �, -••---•-•------••-..... .... •. ............. •.............:.......Date .. Final Inspection by: ..............................•----••- - ------ • •--•• - •---.•. •-- - L--....--:_.._. SAN J AQUIN LOCAL HEALTH DISTRICT Li 13 24 1"AID 0— eu 7/72 3 M