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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate!._ �.1 . ._� _ _ - r._ ,s �r -- ..:. ............ p Date Issued ..............................................:.......... 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: JOB ADDRESS/LOCATION ..�:�....--�-- �..................;---...;..... ................... ...CENSUS TRACT .......................... Owner's Name _.. rl��t. 1 ..._....1 - Phone ......... ................... ..•...... Address ��* '. : City ................... .... ...... ....................... ..License , a• �-... Phone Contracto ' F r s Name c� �y •.- �:�'4•�-� .................... T installation will serve: Residence❑Apartment House 0 Commercial[]Trailer Court Motel ❑Other ............................................ t ' Number of living units:./- Number of bedrooms Garbage Grinder ........:... Lot Size ... . ... .- `' I....• Water Supply: Public System and name ......................................... •-- ......__...............I........................Private, r Character of soil to a depth of 3 feet: Sand 0 Silt Cl Clay Q Peat❑ Sandy Loom 0 Clay Loarr#,P Hardpan 0 Adobe Q Fill Materlal ............If yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r{ 1 NEW INSTALLATION: '(No septic tank or seepage pit p Itted if public sewer is available within 200 feet,¢ PACKAGE TREATMENT { ] SEPTIC TANK ] Size.......................•................. Liquid Depth .......................... ' Ca acit Type -------------------- Material-_------------....... No. Compartments - .p Y _ -----------_-- Dista ` Foundation ... Prop. Line .............. nce. to nearest: Well ____________ _ � ---•'•"'--'-"""'•'� O LEACHING LINE ( ] No. of lines ...-�--------------- Length of each line.... ... Total Len th tai .. 4 n..........- 9 'D' Box .. ...:_.. . Type Filter Material . .............Depth .Filter Material ............................................ l?l Distance to nearest: Well ...................... Foundation .................-.:--.. Property Line ........................ SEEPAGE PIT ( ] Depth4X.19A/1Diameter ._---------_-- Number -----10---•-:............ Rock Killed Yes, _. No ( -------- Water Table Depth ------------------------------------------------Rock Size •----------- ••--------- Distance to nearest: Well Foundation ----------- ------ Prop. line ...................... r REPAIR/ADDITION{Prev. Sanitation`Permit# ............................................. Date .................. 7.4?�y r 71 Disposal Field (Specify Requirements) � - -,�/••-.- -�-�---.._-----------------------------------------------••-:....._....._.._. •------------ --- ---:----------------- --------..--------------------------------------------, -------- --------------- ------------11-------------------- ----•--•--------------------------------------- - ------------------ --------------- -----------------------------------------------------------------------......................................... . 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 Lows, and Rules and 'Regulations of the San Joaquin Local Health,District. Home owner or licen- sedagents signature certifies the following: "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 --------------------- 3itle ------------...........-•--- ..... ........ If�ha owner) I _ FOR DEPARTMENT USE ONLY -- ` `� APPLICATION ACCEPTED BY ---- = - ELATE .J .�------,.V._� r BUILDING PERMIT ISSUED ........... -------- ........DATE : -•--• ADDITIONALCOMMENTS -- ___1---•---- ..............•----------------------------•----..._.-.......................... ........ •--.---.......................... ....... ------- - -------• ------- ------•------- ----•---._...---•--•----•----•- ------...._. •-------..... ---------------- -- Final Inspection by: _._....__- - ---..Date .... . ..... :• EH 13 2}� 1-68 Rev 514 SAN JOAQUIN i CAL HEALTH DISTRICT 8/7h 3M `C)