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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �... ...........' ' �_ ._._..... Permit No°� �.., (Complete In Triplicate) " ••.....................•,--_.., This Permit Expires >I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 ... _.. . ......................................CENSUS TRACT Owner's Name �y :Qs �� :......... - _ ............... .....Phone ..T..�.�.-. .5'. 7...... ....... ... .. ..:.. .. .. 1 op Address City .. 9 .}-�. ._.... ... Contractor's Name ........... . . .. .. .. . ; :c d'3*` ..........................License # :✓� ..... Phone ..A16.4--i.,.407... Installation will serve: Residence Apartment House Commercial:❑7 ailer,Court 0 Motel ❑Other __ ` +__.... Number of..bedroo s*��.��-.. _� G ba a Grinder( Number of living units..__ - g ' �:.: lot Size . ..�.. ._ .,l..T�---- Water Supply: Public System and name ..-........:.. .._..• *• ,......-------- -`est. r--•--•-----•----•--•--Private ❑ Character of soil to o depth,of 3 feet: Sand b Silt❑ Clay E3 N, Peat❑ Sandy loam ❑ Cloy Loam 0 Hardpan ❑ Adobe ( (' 1I Mbterial .... .,_.__ _1f yeS,4e ............................ (Plot plan, showing size of lot, location of. system�in reloti on to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit perm tted if publfcssewe. r is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK �ze\.._....$......X;? ,---••••....... ... Liquid Depth ... '......•.._.._... Capacity AW_ Type ....... .. ........\M- aterial11.e,_,. No. Compartments ...��`.......... r x° �sta`ce to o.'-nearest: Well ........ .i......Foundation _...fO........ Prop. Line ..-�� .......O LEACHING LINE No. of Lines . Length o ea e.. .tS -•.••-.yy. Total Length .., 5...............s DBox�"`"""`rType Filter Material . '., sDepth Filter Md`terial ... ..•. r II .�-- Distance=to-nearest. Well Foundation .... .. ...... •..................... , .�Q �..... .. Property Line .. "T� i SEEPAGE PIT ( Depth ..._. .�_____ Diameter ... ,.._..... Number ......... 1............. Rock Filled Yes "] No Q Water Table Depth _. �. �,I .Rock Size a.l�r.'._.�m...yf.�:. ¢ Distance tb=�negrestl'Well . ... .............Foundation ...C.�}... r..... Prop. Line ... ....f......... i REPAIR/ADDITION(Prev. Sanitation Permit . . Date aim Septic Tank (Specify Requirements) ........ ........ f0 Disposal Field (Specify dgUirements) ••--••••••.... - .......-••---------------•-........-- ..... -------.._............._.....------------- T ----------------- ------1.._....................................................................... ...•-•............................ �....... ........................................................ ...........I..................................... .............. -•---------- ------•................................ (Draw existing and required addition on reverseside) I hereby certify that 1 have-prepared this application and that the work will be done lin accordance with San Joaquin County Ordinances, State Laws, aod)Rules and Regulations of the San Joaquin Local Health District. Nome 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." f Signed ............ .....,.—.y..... ......... ... . --.---- -------••---•-•-- -••--- Owner By ------ -------- "1� -- - .............. . Sitle .... -......... (If other t n owner F4 DEPARTMENT USE ONLY j vv APPLICATION ACCEPTED BY •......................... DATE ... ....... BUILDING PERMIT ISSUED --------------------------------- .._........................... ADDITIONAL COMMENTS . ,j; $= Vl ...................................................................... ---_�.. v_`""_"-----.._ -_ :r....................•-------- -... ...............•-------•--•-----.........................--................. ...............................................I.................... .................. ..-•---•---........ ---------. ... ....................................... , - :..... ------------a-�•" Final inspection by. ............... .. D t SAN JOA IN LOCAL HEALTH DISTRI E_ E•i_13 24 1-'68 Rev. 5M `