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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete-in Triplicate) Permit No. _..._..._'..._ ..... p p - This Permit Expires 'I Year From bate Issued Date Issued .�j�'.�?��:.75 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, 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....... . �- - _/j l/V s'o ..� ..- . -- - ----....-•-�•.•----....•........�Gl._. ............CENSUS TRACT Owner's Name -0.41 ° ...... __/_�.�-.�../..�......___�r-!�.�.,F/.�.�_� •_-•-----r----- Phone �`.�,� •7� d Address ._.... /�U 7 �� D ..... T��—citv .............•----•---......._..._....-----...------•--._................... Contractor's Name ....—C._�.44 •,---,,., .•.License # Phone --------_- ----•• ---•• .............................. Installation will serve: Residence ❑ Apartment House-C3 Commercial ❑Trailer Court 0 MotelOther ............................................ Number of living units:-/-57- Number of/bedrooms /t�_.Garbage Grinder ------ Lot Size Water Supply: Public System and name ................................ ------------------------------------------------------Private [ Character of soil to a depth of 3 feet: Sand b Silt❑ Clay r] Peat❑ Sandy Loam Cj Clay Loam ❑ Hardpan ❑ Adobe C) Fill 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- it permitted,If public sewer is-available within 200 feet,) PACKAGE TREATMENT j j SEPTIC TANK ' /�(T•�� C1r j e...--•-•---•-•••--• ..........--•-•-••--------- liquid Depth .......................... I Y Capacity -------------------- Type -----_------•-----•- Material----------............ No. Compartments _ Distance to nearest: Well ,-- Foundation ----------------_- Line ...................... LEACHING LINE [ j No. of i_ir ,.sr --l. T� g .----••-•----•.th of each rine...................... Total LendtHV ............................ 'D' Box ............ Type Filter Material ......:_.''_--------Depth Filter Material 7 V Distance to nearest: Well ......___________....... Foundation .................-_.... Property Line L ---••-•.............. . SEEPAGE PIT } j Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No [] Water Table Depth .Rock Size Distance to nearest: Well ----------------------------------------Foundation __-...--.._...._.... Prop. Line -... ................. REPAIR/ADDITION(Prev. Sanitation'Permit# ................... .----__-•.• Date 0 Septic Tank (Specify Requirements) ......---... _._•-------------------•-----..-- .._..-_--•-----...., 3 Disposal Field (Specify Requirements) FIG,_ r _ ..x...... -------f.a............... U ----•- (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 Regulons of the San Joaquin Local Health District. Horne sed owner or liten- agents signature certifies the following: - "I certify that n the erFormance f the work f r hick this permit is issued, I shall not employ any person in such manner as to becom sub' to Co Compen t' la of California." Signed . ._. . -- - ------ Owner By -••---....---••------------------------•--......-__......_......_.._.. ------- --------_- ........... Title ........................... (if other than owner) FO)f D�11 �ARTME USE ONLY APPLICATION ACCEPTED BY ... .. ._'. ... . ...................... ............. �AE ._.. .. - Z. '.._...---• - BUILDING PERMIT ISSUED --------------------•.._ , .._.._ ADDITIONAL COMMENTS . -•-------------- ----*••--•-..........- .....__.............I............................. .............................. . ....... ---•--••.. . . . .. ... ....................... •-•-...------••._..........----- Final Inspection by: •'-•• . • -- .Date ..... SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 13 24 1.'68 Rev. 5M.—- 7/79 1 M