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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ....................: ..............I..............__................ Date Issued . .............................................. This Permit Expires 1 Year From Date Issued 013 22.o— 3 Application is hereby rhade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance witount ,O ydinance No, 544 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCATION ....!�. ._ ISI-_-.Srf.G .;_, x .51 -._......CENSUS TRACT .......................... Owner's Name ...... ---- .:........ :................. ..... Phone _..._........................ ,p Address ... --.._... . .. - ....... - ..... /rS-•�tS,.'Aicenitt --- Contractor's Name ...... .�J__ Z ------ se # 1YX. .Y..- Phoney'q.V ... Installation will serve: Residence Apartment House, Commercial '❑Tralier Court -�— -Motel ❑Other -------------------- Number of living units: -- Number of bedrooms ---r3....Garbage Grinder .... Lot Size . ................ Water Supply: Public System and name --------........-------------•__.....----•-•---...___.__ :__................_..------- .............Private Character of soil to a depth of 3 feet: Sand U Silt❑ Clay E] ' Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe'0 Fill Material _:......_..- If yes,type .................. {Plot pian, showing size of lat, .location of„system in relation to wells, buildings, etc. must be placed on reverse side.) y NEW INSTALLATION: (No septic tank or see ge .pit_permittted If ublic sewer is available within 200 feet,) f (� PACKAGE TREATMENT [ ] SEPTIC TANK[ Size. ..-••.rY-- _.._.�•::r•___.... Liquid Depth _--q................... � OBles m Q ' rn Capacity __...__.._. Type �Li!-s��.'_-:�__ Material.. ._ _ _ No. Compartments Distance to neat:,Well .......... Q _ ___ ____-_.Foundation ...,1 P .... Prop. Line . LEACHING LINE No. of Lines . Length of each line.......?,47/4._ _ . Total length .� 0 ....... 'D' Box ... ... . . _, , ..�..... Type-Filter Matenal .......6.9.--Depth Filter Material ------14........... Q Distance to nearest; Well .......6101Z Foundation ...�1 . ......... .. Property Line :_: .. .._....... SEEPAGE Pia' [ l Depth __________________:, ,Diameter ..__...____. ... Number ............................ Rock Filled Yes Water Table Depth ................................ -Rock Size .. 99� Distance to nearest: Well ....................................:...Foundation .................... Prop. line ...................... , REPAIR/ADDITION(Prev. Sanitation Permit#;................... . Date , SepticTank (Specify Requirements) ...................._-----_-------•--_-- ---........................ ---------........................._....------------ ----------- DisposalField (Specify Requirements) ------------•------••------------------------- --------------------------•--------------._.. ------- ............................. ----------------------------------------------------------------------------------------------------------- -------------------------------------------------------•---•---.-.........------..__.----- _....-------- --------------- ............ -------- ......................................-_--------------...........................................................-............-•---------- ------ (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.” t Signed .. --•------------------- - --- •------ -- ...... Owner 1J f 0 By ---------------------------------- - .... 4 __. .Title ---1----- ._... ---.-._............. - (If other than owner) FOR DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY ............................ I DATE ...... _ _4: Z1__.�.............. BLLDING--PERMI-T--ISSUED ............................................... -------.......... •=--•-----____:_:....::......DATE ............................---- ADDITIONAL COMMENTS __::::....__.-_ --------------------------------- .................................................. . - -•- -. .....�. r • Final Inspection by: ...:............. .. .................... -•-= ...................•...................Date._.. ...�,f �. .............. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M - 7/72 3 K