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" FOR'OFFICE USE: APPLICATIONS FOR SANITATION PERMIT - u�_--- Permit No. (Complete in Triplicate) -------------------- --------------------------------- Date Issued ----------��------•- `U' a �j ----------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joa 6n Local Hea District for a permit to construct and install the work herein described. This application is made in co pliaQ with Co my Ordinance No. 549 and exist' Ryles and Regulations: mss / ' G --CENSUS TRACT JOB ADDRESS/LO TION. 4 `�`''� / ��_Wit. C - --- Phone Owners Name , --- ------------------------------- y -� � ` -� Address -------- t ---- - ------- -�-lY�-�S - ---� - -�_C�-----------•--. Cit \ Contractor's Name �c° `�' -%- - ------------------------ License # /�/,.�`.�' Phone �.� Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -------------------------------------------- .......... Number of living units:-____/__ Number of be ms3__.____-Garbage Grinder '- --2_._ Lot Size 61-* �-J-..J--�/{� t, j Water Supply: Public System and name ----------� Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ill Material _� ' If yes,type ---------------------------- (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 (,� /S*e_j____�� s.- _________________ Liquid Depth .. ��---------- _ Material _'er Q. Compartments ................�... ----- CapacitY ----- -/-=�-�='_-- Type&_ � p � Distance to nearest: Well ____--------- ------------Foundation ___�a__. ------ Prop. Line . _...___._------ - LEACHING LINE lod No. of Lines ____-:__�--__-_______- Length of a ch line-- t- ------- Total Le gth ........... Ile �3 Si ----•- _De Depth Filter Material _ - .-� .-------•-----�---- `D' Box - Type Filter Material ..........._ ______ p - -- - Distance o nearest: Well __SSSS-'__._______ Foundation -----/o/ Property Line ------------------•----- __ Rock Filled Yes '�o 0SEEPAGE PIT � Depth �� ____ Diameter �_�_______ Number ____-_�---________ Water Table Depth -------._-. --------------------- Rock Size 2 ------------------ Distance to nearest: Well ____ -_______________-Foundation/_�_--_____--___ Prop. ------•----• REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ___________________________ --------"----------------- Disposal Field (Specify Requirements) _______-____ ---------- ------------------------------------------------------- ----------------------------------------------------------------- -------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Owner Signed ------------------------------------------ ---------------- �-- --------------------------------------------- = -------------- Title ---- By (If other than ow, e FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY _-____- -- -- ____ DATE _-__�S-- 3J"- '------- BUILDING PERMIT ISSUED ------------------ - ----- ------- --- -----------------------------------------DATE ---------------------------------------- ---- ----- ADDITIONAL COMMENTS -_________--__ ------ ------------------- ---- --------------- - =-[a( Pia=_:C _ - --------------------- - ----- ------- --•--- �} ------------------------------------- ----- ---- ----- Final Inspection by: _._.__ Date __. --_� __'l_- --��--------- ------- --------------------------------------------------------------------------- ---------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M CO-