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FOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT 0 • --- ............... Permit No. .. .._ .... . (Complete in Triplicate) .... This Permit Expires 1 Year From Dale 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 made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... -_c' z-gr _.._ ... . ........ .. .�.lr.._........................I....CENSUS TRACT .............:.,.......... Owner's Named-.---- Phone ............. _.......... ----------------• ....,...... Address .... .!n .9_fS_....... ....... ••---•_..- City --- .............................................. . Contractor's Name ...... •--.....rte.:............License # ..._ Phone .............................. Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court C1 Motel ❑ Other ................................. ---------- Number of living units--------I.._ Number of bedrooms --- ....--Garbage Grinder ............ Lot Size •...---. ....... Water Supply: Public System and name ........................... . __...Private L_1 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ---------------------- (Plot --__-................(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.permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t ] Size........................................... ... Liquid Depth .................... Capacity ......... .......... Type ------------ ....... Material...................... No. Compartments ..........--.......... Distance to nearest: Well .......... .......................Foundation ...................... Prop. Line ............____-----. LEACHING LINE [ ] No. of lines .... ------------- Length of each line.............____........... Total Length ._.........._...____...___.. 'D' Box ............ Type F;Iter'Material'_....--'•-""'-:•--Depth Filter Material ................................. ....._... Distance to nearest: Well ........................ Foundation _...__..._.............. Property Line ..............._........ SEEPAGE PIT [ ) Depth ----------_......___ Diameter _-.............. Plumber ..__...._................... Rock Filled Yes ❑ No • Water Table Depth ......Rock Size Distance to nearest: Well ........................................Foundation ..__...-_......_._.. Prop. Line ...................... 1 REPAIR/ADDITION(Prev. Sanitation Permit°# .--......................................... Date .................................. i Septic Tank (Specify Requirements) ................................... ............................... .......•------------------ ......... -------------------------- Disposal Field (Specify Requirements) --.. ....- ��--. -6 r`7----- •--- . ..... ...�J—� ..... -- 1_._... a-�, ... ..._ _r....�... ._r t............... ---------------------------------------------------------------------------- --------------------------...--_.................... ......... -•-•---•-....._.....-•-----•-....— - (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, l shall not employ any person in such manner i as to become subject to Workman's Compensation laws of California." I Signed _. Owner I By ................. ...•---•-•------...---•...•-•._.. ............ ...-----------.A. Ti ...� AA_.. .-- a.. . . ....-----................._............... (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. --- -- ..�.... DATE _..-.....1-2 2y..._....... BUILDINGPERMIT ISSUED ...........?...............•......_.. ............... ................................................DATE ........................................... ADDITIONAL COMMENTS ...............................................................--........................................................................................ ..._. .. ._. !J... .ti. --•................ ...................... ....•--•--..._............._..---........_._..._.. ... . . Final Inspection by: ....... . =-• ........... Date '�G" SAN JOAQUIN LOCAL HEALTH DISTRICT iW,W a ,. 1 1 'M 7/72 3 M