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t FOR OFFICI USE: APPLICATION FOR SANITATION PERMIT l* - . 1r;_ . .. .� _,r. __(Complete In T4plicate). .. .._.:.. . .._ _ ., ............. (�........ Permit No 7-�.115 This Permit-fx Tres 1 Year From Date Issued Date Issued ..V-.z::�- Application is hereby made to the San Joaquin Local Health District for a permit to construct and In the work herein described. This application is made In compliance with County Ordin nce No. 549 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCATION 'v.I..-�...:... - D ...................CENSUS TRACT Owner's Name .............. Address ----•. _ _ .r _-: w= Phone ....... . Contractor's Name --- z ._._,License, � _: -.Phone _ �9 Installation.will serve: � j tResidenceXApartment Houseo Commercial OTraller Court 0 f _Motel❑Other................:........ Number afliving unit s:....../ Number of bedrooms ` Garbage Grinder -•--- _...�_ Lot Size Water Supply: Public System and name . 4 . - Private Character of soil to a depth,of 3 feet: Sand�]'�•Silt 0 Clay 0 Peat 0 LN(Sandy loam ❑ Clay Loam Q Hardpan d Adobe"' Fili Materlal If yes,type............... 4 i .. ............ (Plot plan, showing size*,of (ot,,location of system in•relatioh to wells, buildings, etc. must be placed on reverse side.) f NEW INSTALLATION: (No s ptic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT ] SEPTIC TANK,• �:,� j Size... ` - qui Dep ...................... Capaoty � -- Type . __._.- Material--_ No Compartments Dista ce to nearest: Well .._.._-----• _.._...Foundat€on _. ____- -,__w 41 . Prop# Line ...........-.......... LEACHING LINE I j No. of Line/- T e Filter Length of each line..._______•.__..... .Nota! Length I .__ :..................... Yp � 'p• Box i �« � ................... Depth Filter Material`'`-_%............_...�..!.... --.........--- � er Material pistan�ce to nedrast:;We11 ........ .....• _-•--- Foundation ...-•-----•.._.....:---. Property Line T ri \ SEEPAGE Piz [ 1 Depth . Diameter � . i .F... ...., l : ' :... Number ............................ Rock Filled' Yea No U Water Table Depth ---------•_:.:....-�--------------------Rock-size .... .......................... t Distance;to. nearest: Well ....................•----.....:---=.....Foundation _................... r i ...................... P op. L ne REPAIR/ADDITION#Prey. Sanitation Permit# . . :.... Date Septic Tank (Specify Requirements) - -•-- .......:........ . I` Disposal Field (Specify Requ€ret—e ts) ..-..l6__'_X '.. • ........ ------------- •---------------------------- q -----------------••----- •••-......_._...___.--•----.'•� _1 ; {Draw existin and required addition on reverse side) I hereby certify that 1 have prepared this application and#hat t1in work wil# -be -done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Moine owner or licem sed agents signature cel tif€es the following: t i "I certify that in the performance of the work for which this permit is issued, ! shah not employ any person in such manna as to become subject to:Workman's Compensation laws of California." f Signed -------••- Owner ------- - (I ther n owner) l F DI:PARYMENT USE ONLY APPLICATION ACCEPTED BY ------ -- - DATE.,..-.T:`�-,.7 :::-=> �I BUILDING PERMIT ISSUED -------- .... --•------------- -----•----------........._DATE --------_.._.._.._.__......-....----=----•. '. ADDITIONAL COMMENTS ----------•---•- ._.....__... ------------------------•---. --------...------------...-----------• --------------- ------•----------•-••------••--- ----- ••-•----•----•--- ........... ....................••----•-- ---•-•••-.---- ........ :.._...---•--- - . . Final Inspection by: -------- ............ . Date ..-. �-j- �� ........... .... . EH 3 2!, J-6f3 Rev, SAM JOAQUIN LOCAL FIE LTH DISTRICT 8/71 3M i