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' ',FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - gip_7y----- - ' �' --- (Complete in Triplicate) Permit No. -- --•-- This Permit Expires 1 Year From Date Issued 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 Cgunty Ordinance No. 549 and existing Rules and Regulations. , /n n JOB ADDRESS/LOCATION . '7"'I��_ •�'T-R �Ta�7�r 1 ...,CENSUS TRACT Owner's Name ........ / �/ ....---•.................. �/. _......-./ Qeje !W /po�{ ---.....-. Address Phone ............... T.@......... ....... ........ . ........................... ....••------ CityS'Tvc+ETo ' Contractor's Name .. ��.�� . ... . ..... .. . .�_ ...--- -------•--•--•-....------._......__..--- . ..-C-.......License # . ... - _.......... Phone ----------- Installation will serve: Residence A Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedr oms ...__..Gar a Grind Lot Size ..... ................. Water Supply. public System and name . - - ..................... pP Y� � � �r . za -_--Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt ClaY ❑ Peat❑ y Loam Clay Loam [] Hardpan ❑ Adobe ❑ Fill Material ..-- type . [ 1. - .. If yes, .- -.. . - ---• �- ---- � W (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,) PACKAGETREATMENT [ ] SEPTIC TANK ] Size......................... - Liquid Depth .. ... Capacity Type .... - . Material-. ._ . ..: No. Compartments Distance to ne'grett: Well _ _ .---._.____-,•Foundation -. . __.... L _. prop. Line .--------•.- LEACHING LINE •-------• ( ] No. of Lines — . Length of each line Total Length , ' Box Type Filter Material .._ --------- Filter Material ... Distance to nearest: Well .... ............... .. Foundation . ........ Property Line .... _ SEEP.., ALIT { ) 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_.- 1 Septic Tank (Specify Requirements) ------ -- ....... �-spasal Fy��Jd (Specify equirements) - ..- ._..... _ . . .. .. ._. ...__....•.• �-�[ .4r .. .A��(Drdw�. . ............. --.----------------- existing and required addition ------•--an 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 following: "I certify that in the pe orntance of the work for w ich this permit is issued, I shall not employ any person in such manner as to bec a subje Wo,k n's Co pensation ' ws of California." Signed . �Q.i.. . BY .. .c , ....................... ,1 fIf other than owner( Title F DEPARTMENT ONLY APPLICATION ACCEPTED 8Y . ,. - • ._-. DATE ��-._-^'- BLIILDING PERMIT ISSUED .... � `-� ---� � 7 ADDITIONAL COMMENTS DATE .. ...............-.......... .....-----.. ........... . ........ .._. . ------------------. ............... Final Inspection b ..... ... .. . ....... ..... ..........---............_......----...--•--.--- - --------------..._ ... ._ .---------------- Date ............. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1.'68 Rev. 5M