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OR.OFFICE USE: ' APPLICATION FOR SANITATION PERMIT __ ----------------- ---------------, ---- Permit No. _.(Complete in Triplicate) ---------------- i 77 F2 This Permit Expires 1 Year From Date Issued Date Issued _ _ I---- _________________ -----------_------------_-___ 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;Ogdi ante No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .-.------P-Z_ L41------ -----�--------6 - CENSUS TRACT j y Owner's Name ! w �^Y ------------------------------- -------Phone _ V -- Address _q 0Q _t9M . City ------- I ►------------------------------------------------•-- Contractor's Namur'st-c_1<J'dS-_-----c -e -1-L _ n�------.License # ��%�;Y..-- Phone Installation will serve: Residence X Apartment"House'❑ Commercial []Trailer Court ',❑ Motel ❑Other ------- =-I--::-------- Number of living units:--- - --,-- Nbmber of bedrooms ___A=-Garbage Grinder -__:________ tot"Size ___ -�------�1��--------- I hoz.' { 1 rw w v Water Supply: Public System and name -------------------- Private,( Character of soil t6'd ❑depth of 3 feet: Sand' - Silt❑ ' -Clay-ED Peat E]f Sandy Loam El Clay Loam ❑ Hardpan [DAdobe [/' Fill Material ------------ If yes,type ___________________________ + (Plot plan, showing size of lot •location _cf system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic_tanF0r 'seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![] Size- :'--------------------------------•------------ Liquid Depth-------.------------------- CapacitY --------` -----; Type -------------------- Material-- ------------------- No. Compartments --------•-••---------- i Distance to nearest: Well _________ _ _ ________ _____ ______Foundation ---------------------- Prop. Line _______________...-__ LEACHING LINE �K] No. of Lines ------ __-: Length of each line.____.fi � g f =---•----- ------------ Total Length -----�D---------•-- .W 'D' Box :!e------ Type"Filter Material !_____ _��__Depth Filter Material -----------1 - ----l", Distance;to nearest: Well ...... � . ____ Foundation -----.4_4�_______ Property Line SEEPAGE Depth _V-0....... -Diameter T_-/-P Number .-_--____ _-_____-_____ Rock Filled Yes No i❑ Water Table Depth '(�11---------------• Rock Size �r 1. � r/ Distance to nearest: Well _',C�l� _____________________Foundation ____t..V_ ___ Prop. Line ... a1 z REPAI DDITION Prev. Sanitation Permit# -------------------------------------- Date ----------------------------------11 iSeptic Tank (Specify Requirements) --------------------------------------------------- -----------------------------•--------------------------------------------------------- Disposal Field (Specify Requirements] ------------e-4041------ ------- -- "`� _ =--- -- �--- ----------------------------------------------- - ---------------------------------------------- ----------------------------------------------------------------------- ------------------------- i -----------------------------------=------------------=---------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 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 ,-. .x _ -__ ,--------------------------------------------------a � --- caner ----- - O� tBY ---- - ---------------- -Title -------------------------- (If other than owner) FOR PEPARTMENT USE ONLY . APPLICATION ACCEPTED BY ----- ----- DATE .. -.-- --- ------------------------ BUILDING -------------------- -- BUILDING PERMIT ISSUED -- ----- i ------ DATE ADDITIONAL COMMENT _.______ _-�-._- H ` --- -- 1 . ..... r c - ----- ---- atry�� i l f yr �f/ -------- --------- y _------ === = Final Ins ection b -- r 1 G�f r� mate ` AN JOA;Ql11N,:L eFIEALTF�ICT�� E. H. 9 1-'68 Rev. 5M