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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �Jo Permit No. t,� `.................................. 11 r.•c•7........ . (Complete In Triplicate) ................................................ This Permit Expires 1 Year From Date Issued Date IssuedA/ 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 }frith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ZZS... OF...6.. S _017r4ll�........ _....._ CENSUS TRACT PA Owner's Name .._. ! 7Q¢_...__._.... S7....... ...................r........ ..... --------.Ph ng .................................... Address -----------•-------------- Cil i+ � ..... ......................................................... a / Contractor's Name .SAA-14.........................:.................••-------.............License # ,� . ............VJ Phone Installation will serve: Residence (]Apartment House 0 Commercial NTrailer Court 0 Motel ❑Other ------------------------------------------- Number of living units.-........... Number. of bedrooms ............Garbage Grinder ............ Lot Size ....1.,-.Q ................ Water Supply: Public System and name ---------•-•--••----------•----•----.•---•----•................................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loam Clay loam ❑ Hardpan ❑ Adobe❑ 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 -Ferrptted if public sewer is available within 200 feet,) / PACKAGE TREATMENT ] SEPTIC TANK 41A7x` G 111 [ Sr&e---��------- --• -_L''-`----- Liquid Depth .......................... �@ Capacityf!L .. Type .1..�! :.. gMaterial. !c-� - . No. 9)mpartments .... ..f...... Distance to nearest: Well ... G>rQ l.._. FouA ion .... __. ..._. Prop. Line .. [ ] No. of Lines ------=------------��length of eaclti fine.----- ------..._..... Total Length ............................ ' Fi 'D' Box ------------ Type Filter Material ......:.............D pth Filter Material ......____..._......_._...:__.._...._....... gEQ Distance to nearest: Well ........................ Foundation . Property Line SEEPAGE PIT E } Depth -------_ ......... Diameter ................ Number .._....----..-............... Rock Filled Yes ❑ . .No.c] Water Table Depth .........................................Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit,# ............................................ Date ..................................I Septic Tank (Specify Requirements) ........................ ------- - -- --- - -- ---------- Disposal Field (Specify Requirements) .... ca' .... ...C.. d�.. ................... .. �1 ............ ------- ----------------------------------------------------•-------._..-.•.............................__............._..---•--. .........................._..._._-.--.......... \1 .......................................... -----------------------•-••............................................................................................................. V (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 Latins, and Rules and Regulations of.the San Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed :..:. .. Owner Title ...... •- -•---•-••-----••----• f then t an aw erj FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -- ---- ---- -------- .............................................. DATE ..... "". :`-:. ....------... BUILDING PERMIT ISSUED .........:............. -----------------------I.................. ..............I.............._....._....- ......DATE .....---................................... ADDITIONALCOMMENTS ........................................................ ..................I...... .................-......................................................... __•.................................................... ..............._ .............................................................................................. '....• j ....................................-•----- ...... ... ......... ... ... .. ............................... .. a_..___• Final Inspection by: ............ .................................Date ...._.. ...... SAN.JOAQUI LOCAL HEALTH DISTRICT E. H.13 24 1-'48 Rev. 5M 7/723