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FOR OFFICE USE: 77.�-J- r APPLICATION FOR SANITATION PERMIT Permit No. .............. �. / (Complete in Triplicate) ' Date Issued .3—�-:�� f ......_•__•.....................................I--.----- This Perm It�Expire$ f Year from Dat*Issued � Application is hereby made to the San Joaquin local Health District fora 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: s JOB ADDRESS/LOCATION � . _ . . . ......................CENSUS TRACT ................:.......... Owner's Name ...]Bo. � •� ... ......Phone Address . . . ....... .... .. ..... 'V................ City � Tm l.................... ... ... ...... ..... Contractar'sName �. ..t. .,.. _. 3:R '1. ' ._' .__ ©!t s:....__1�. .._...License '# :........ PHone ..: * ?. Installation will serve: Residence bt Apartment House fl Commercial [3Trailer Court C] Motel ❑Other ---...-------------:........................ Number of living units:-.,-.------ Number of bedrooms �n7......Garbage Grinder ............ Lot-Size ........ .-��' �......... l " Water Supply: Public System and name .:...............•---....._....._...........--•--- __.'...--•-----•-_--••-----�- --......................Private, l i Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam (] Clay Loam Hardpan p. Adobe kj_Fill Material ............ If yes,ripe •.............. ............ (Plot plan, showing size of lot, location of system in relation to wells,.buildings, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septicitank or seepage pit .permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT, [ ) SEPTIC TANK I ] Size.......................................... ....: .Liquid Depth ........................... —Capacity # Type ... ............ Material...................... No. Compartments ............:....:.... = Distance to nearest: Well ...........:L.......................Foundation ........ ........... Prop. Line ...................... LEACHING LINE, NDo.Bo Lin es - Length of'each line--t.... . Toto) length t Type Fri ter' Material ........Depth Filter Material ............. ........................ Distance t' nearest: We ------------------------ Foundation ..-•-.----..__...:._...Y_ Property Line ......-...............--� j SEEPAGE PIT [i J Depth ....'-I-------------- Diameter -----------------Number Rock Filled Yes ❑ .No (D Water Table Depth ---•--•.........................................Rock Size'._............................... • Distance tonearest: Well -----•------ --------—Foundation ._............_:..__ Prop. Line ...................... ' v REPAIR/ADDITION(Prev. Sanitation Permit# --------.---------------------- --------- Date ............................. ;I , Septic Tank (Specify Requirements) ..................................... ............... ::.................................-•-.... ..... O Disposal Field Specify Requirements) _C- ? ? 7Y12 . _._ ?.9y?/4 '..........................................::. p r � lag- ......... --- ....--- !? t -------•------ -------------•----•---•------ -------------•--._. ...................... .............. J(Drow existing and required addition on reverse side) 4>° i 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'Heolth,District. Homs: owner or licen. sed agents signature certifies the following: "I certify that in the perfor ante-of the work for which this permit is issued, 1 shall not eimploy isny person In such manner as to becom"subje fo ar man"s;:,Co pensa on laws California."14 , _. Signed . -- ----- ---- - -------- • • ---•---mer By --- -------------------------------------------- Title _ ................ (If other than owner) _ FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY - T ---...DATE . ..-. .....�i P...�.: BUILDING PERMIT`ISSUED _.`:'"._ ...' .`_....."'.:: - --=------ ------ •._..._DAT[ ... ..: ADDITIONALCOMMENTS ----- ---•-------------------- ----------; ---=-------=........:.............. ------- ............................... ......... F 1 r �.. t I `//--�J -• ---- -----------/_-„�`--- ---- --- --P --- - - ••- -- -' Final Inspection by: ----- - _..Date � . . ..�:- ---- -- -- ------ ........ .... ..EH �3 24 1-'8 Rev• S,M SAN JOAQUIN I. HEALTH ST8/7h 3M