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`FOR OFFICE USE: r, APPLICATION •FSR-SANITATION-PERMIT _ Per No:--....5..:.'�.,•`•?p �.._... ,. ...Y.....Y. _:;� ICom0lote iEn TPiptirdtel E f ......................... .. _ '` .y;Date Issued .�`.•��••�•• This Permit Expires ] Year From Date Issued I Application is hereby made to the San Joaquin Loc Hellth District for a permit to'construct and:install the)work herein described. This application is made in compliance with County Ordinance No. 549 acid-6xisfiing Rules and Regulations: ( Qom,, t�.CENSUS TRACT .......................... JOB ADDRESS/LOCATION J..`7.,�.- .�._. }•�"x.+�•-.......... . _ . Z1'ra � .......Phone ..................• ,�mOwner's Name ... .............• --------.......------...,_.....__._.....:.............:� ✓" City _C ....... Address . .... ............ ,. Contractor's Name .-. Phone ..._..License �..,�. ., . .. �= - • � -•-• Installation will serve: Residence 2kApartment House Commercial ❑Trailer Court❑ Motel Q Other,......... x Number of living units_____________ Number of bedrooms 2i':.......Garbage Grinder . a__._,, L''at`Size �.-3.. �Z&Q....... •-------•• Water Supply: Public System_and name ... ..............�....... ............ r .. ----••_....Private __.. P � to Character of soil to a depth of 3 feet: Sand [J~ Silt❑ Clay�Q Y Peat❑ Sa dy,Loom Clay Loam ❑— Hardpan Q Adobe 0 Fill Material _..---_-.... If yes,type ................••-,•------ Y (Plot plan, showing size of lot, location of system 'in relation to wells, buildings, etc.} must be placed on reverse side.) N S f NI:W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available-within-200 feet,j PACKAGE TREATMENT [ ] SEPTIC TANK.1 ]. f ' . Size-------- ................................. ..........__ Liquid De pth _.... ............. i Capacity ...... ........ Type -------:k........... Material-------------.... No. Compartments -----_----._....-_-.-......_ Distance to nearest: Well ........ ................. o ................. Prop. � Line :......:----._........ LEACHING LINE [ ] No. of Lines ------------------------ Length of each line............................. Total Length ._..__.�.._•.......•--•- 'D' Box type Filter Material ................... Depth Filter Material ...................:........................ Distance to nearest: Well ........... ........... Foundation ......................-- -Property Line .......... Depth .• Diameter ................ Number ._._..... ...... Rock Filled Yes ❑ No SEEPAGE PIT [ ) p ---......--•------• DepthWater ........... ........•••.Rock Size ................---.---•• ---•• Distance oIn nearest, Well ..............'. _..Foundation _.... ....... Prop. Line ....-----------.------ REPAIR/ADDITION(Prev. Sanitation Permit�# ....--+...............•--- ................. Dote Date --..----------....................) Septic Tank (Specify Requirements) ---� '� - a a e- ............................. ---- Disposal Field (Specify Requirements) .._.,_.. - �-3� -� ---------------------------------I---- ..----------•- ----.-.....-----------•-•-------.........-•-••----...------ -__...._. - ... - . --------- = _ 1S �� ------------- (Draw existing and required addition on reversside) 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 I.Icen- sed agents 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 !' � ...._ ...... Title --C,oma^- .elf ....................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.. --.-- - .................. DATE ........_. .:01- ._ f--..... BUILDING PERMIT ISSUED .•• -•-- ............. .......DATE ................... ........... .. ........... ADDITIONALCOMMENTS .._...•-•...... .................. .............................................:.....................--....------............._.._...... ............. •-•-- -----..._... .._.... --- - - -----•-- --- ....----•---•- -----... ._....... ......•---•--- .�,;•... . ..-. ,.,,l ............. . . .................... .. ... . . ._ ........ ........................ . Final Inspection by. .......................:.-............................ •--••....__...Date .,. ,,_'SAN. JOAQUIN -LOCAL HEALTH DISTRICT --- 7/72 3-M