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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ' . - 1......................................�....,..�.. Permit No. � �•- r t. (Complete in Triplicate) " Date Issued .F_Ylf�.Y ................................................ ..::. This Permit Expiret ] Year From 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. 549 and existing Rules and Regulations: ,. K • JOB ADDRESS/LOCATION ....... ...... .. .✓r..._,... -...... _ ♦"-..�"W.... ... ....... {.......: :....• Owner's Nome Y .......dLZ3.... Address •. .. . .._.C[z ... ' City .... .................................... + ..... Contractor's Name _ `': license # � .313.... Phone ��-f40,7-.... ............. . --------._.. .. .. ----------------- •---_. Installation will serve: Residence AApartment House❑ Commercial ❑Trader Court 0Motel C]Other .................i....:._-••-..._........... Number of living units:.-- ------ Number of bedrooms;._..�Garbage Grinder ------r.... Lot Size ....... Water Supply: Public System and name ..................-----------.......'----.._..�_.._._..................:.....................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ x'-.Clay, ❑ Peat Eq Sandy Loam fl Clay Loam 0 Hardpan [Q Adobe ❑',FII( Material ...... ..4lf yes,type ............................ a , (Plot plan, showing size of lot, location of. system in relations 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 [ J SEPTIC TANK I j Siire ................................. .-_.......... Liquid Depth .......................... Y Capacity .................... Type ------------- terial.-:•-= ----- ._`_.... No. Compartments .....I............... Distance to nearest: Well ................Founddtian ..-____............... Prop. Line ................. LEACHING CINE [ ] No, of Lines ...............I......... Length of each line.._._.............. .`_.__.F`Total Length ............................ 'D', Sox Type Filter Material •.•...:.........••..Depth Filter Material ............................................Z Distance.to,nearest. Well .....................::.; Foundation .............. Property Line ........................ SEEPAGE PIT [ ) Depth ........._..R ..... Diameter .........1.:.:. Number ...... ..................... Rock Filled Yes C] No (:1 Water Table Depth ) ..........Rock Size Distance to nearest: Well.................. .Foundation ....... Prop. Line ........._....... _ sn 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 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 fallowing: R "I certify that in the performance of the work for which-this-permit-is Issued,-11 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ............... �ert : ... ... •• ---------............-•=--•--•-•_. Owner By •---- ------ _...- -- -..... . . .-•-• ....._.........:...:.... Title .... .._ .... .. .....................----............._..----...... (if oowner) 3 + AOR DEPARTMENT USEONLY APPLICATION ACCEPTED = = .:..... DATE f .-�. ................ "—BUILDING PERMIT ISSUED ........DATE . .................... ................... ADDITIONAL COMMENTS L R �.r v .............................••--•---............._.-....••................_.. r .... ••...................................................... --_.... ..............._........ .. ... ... Final Inspection by �.�..� ......._. .................... Date '. Cc . SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M 7/72 3'14