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F FOR OFFICE USE- it, 0. ........ APPLICATION FOR SANITATION PERMIT J.-76 14 d�Pti31 .................. ..... �.....`_--•-- ------ .......... ;Complete in Triplicate) ............. �.°:J..Y. :..-...... •------- Date Issued -..._..... This Permit Expires 1 Year From Dale issued .................. ••--........---....... IlrJv f A lication is hereby made to the San Joaquin Local Health D•+strict for a permit to caristruct and install the work herein detribed. This application is made in co liance with County Ordinance No. 549 and_existing Rules and Regulations: 7�.� ..,- NSUS TRACT JOB ADDRESS/LOCATION =++,.- . �,.. -. ` phone Owner's Name .._......... City -.. � off✓, .:............:............ Address ..... �` _ ..._..... �Yu'►riTJ 'L;cens`e # ' ... ............. Phone .............._... Contractor's Name................. - - - .._.-----...----......_-......:-._....---•---•- •- Installation will serve: Residence �ipartment House Commercial ❑frailer Court ] Motel ❑Other -....... •--•----•••-•-- Priv Number of living units;....---. Number of .bedrooms .- _.--...._Garbo_ a Grinder .--._---..-. Lot Size":............ Water Supply: Public System and name -----•------•------------ ............... ........:..... ate [] Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ " Peat❑ Sandy Loam ❑ Clay Loam 0 ` F;II Material -....-.-----if yes,type ............................ Hardpan ❑ Adobe❑ k 'n size of lot, location..of,.system in ielation' t. wells„build•+ngs, etc. must bevplaced on reverse side.) 53 b {Plot plan, show: g • I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'CGr�C, b Liquid Depth PACKAGE TREATMENT [ I SEPTIC TANK{” ] ... . - -` — No. Compartments ............... .. Material. ................ Capacity r... Type - �+ / Distance to nearest: Well .. -------------' Foundation -...... Prop. Line YS - .... C3......... Tota e ..... ........ Length of each line.-.---.7 - .. , LEACHING LINE [ No. of Lines - g Length -.•. s 1Z ,D, Box -• Type Filter Material __...Depth Material ...._.. .. - Filter M •• •- �x�aS/ _ � . k = �'"...., F°vndation .�� 7'c:- Property Line 9 Distance to nearest: Well . ..- -- Depth. .. ...... Diameter . " ------•-- Number ...-... Rock Filled Yes No SEEPAGE PIT + :-•.:....... F ' • ..�� Water.table-Depth ...Rock Size .Foundation . Prop. Line ..................... w Distance to nearest: Well "" ' ..... a Date _.: ---- REPAIR/ADDITION(Priv. Sanitation Permit�# __...............-••-----••-I�••_..._...._. - Septic Tank (Specify Requirements) ............... . Disposal Field (Specify Requirements) --- --.... ••-- i ................... .................... -----•..............� .--••----•--•-------•-_... ------ --------------------- •-.-..-.-.------------•-----"--• -------•- i (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. Home owner or licen- sed agents signature certifies the following: - "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ...----•..-... - ...... Owner .._.. Title -.- x .................. (If other than owner) FOR PARTMENT USE ONLY I - ...........r . .................... DATE ..s" 7 APPLICATION ACCEPTED BY ---.....1/-s�-- .. -•- DATE'........................................... BUILDING PERMIT ISSUED ...................... ADDITIONALCOMMENTS ....... :...............................••---•----•-......---------•--.........._......---•-._...._...... . - ...... -- ............................................................ --.... _..... . .............................. Date Inspection ......... OQUIN "LOCAL HEALTH DISTRICT 7/72 3 4-,, . 1 24 , -,Ln e_., clot