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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ._._........ . . ��. ... Permit No. (Complete in Triplicate) ....................•----------------------------- ...._ ......................................:.................I This Permit Expires 1 Year From Data Issued 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 mode..in compliance withCountyOrdinance` No. 549 an a 'st'ing R les,aannd Regulati ns: JOB ADDRESS%LOCATION . .... IIID. .....` c.�• ' / i ` ....... JOB ADDRESSAOCATIONOCENSUSRA�CT ............... ......... Owner's Name � � ..----•• 7 � -� ...Pho-ne ............. .................--- ---------- . Address ..... . .. ...---- --��------• -- ------------ City ........ - ....... ..................... . Contractor's Name ------- - Lcense # ............. .......... Phone .,A6"67 hla-..4 1... Installation will serve: Reslidence gApartment House❑ Commercial ❑Trailer Court :❑ Motel 0 Other -------------- - •-.-••----- -- O Number of living units:..,......._•. Number of.bedrooms _..._Garbage Grinder ............ Lot Size .... --- .'-----------•• Water Supply: Public-System and name dme ..................• --............................. ..................... - ------......__. ................Private -.'Character of soil to a depth.of.3-feet-. Sand_❑..-..Silt._❑-_..Clay-r.❑_ Peat El Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _ ........ If yes,type .......................... (Plot pian, 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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK T_ J. /_Z� Size.........................................t .... Liquid Depth ....................._ .. Capacity . . Type Materia(....... ....... No, Compartments .................• -- III Distance to nearest: Well --------------.......Foundation ............._..-_-- Prop. Line ----.- .-._.--... E LEACHING LINE [ ] . No. of Lines Total _ .. ... Length of each line...:.:....:.._........._... Length .......... --•.............. � 'D' Box Type Filter Material .._-...._.------.--.Depth Filter Material _.....................................-.-.--� Distance to nearest: Well ... Foundation Property Line .----.-- SEEPAGE PIT [ ] Depth . .. ........ Diameter ................ Number ............ Rock Filled Yes ❑ No l❑ y r. Water Table Depth ------- -- -• , -••--------------- ---Rock Size ------ Distance to nearest: Well ................•-.......................Foundation ............. Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# --------------.-..........,.................. Date ---------------------— -----) `. Septic Tank (Specify Requirements) ....... ._.. T'--. _q.. - . ..-..�..... .......... Disposal Field (Specify Re uirements) .... .... - �.,---••- -� - j © "'� f - (Draw existing and required'addition o verse side) ` hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin j County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies tho following: . "I certify that in th performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec me sub' t to Workma s Co ensation laws of California." Signed _ .�a`... .. --- . ..... By .... - ...... - :. titles,.- �......:.. ... .:..... (If other than owner] I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... .. / . . DATE ........ .... .•.... ..:.---.............. BUILDING PERMIT ISSUED .-.... DATE ..........................•- - ..... _ . .._...... ADDITIONAL COMMENTS ._._......_ ........................ ---------- ------ -------- -•------•-........................ ............... • ---•------ - ...................... - _....------._.. k ---------------- ...........•...._. Final Inspection by: ..... '........... .. bate SAN JOAQUIN; 1L;OCAI HEALTH DISTRICT n o 7/72 3 �H �3 2 .tee o_.. c.■ � __ _- -