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i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �• ------................................ (Complete in Triplicate) Date Issued .. �L ........................ '. ..... -3o-7S� .................. This Permit Expires 1 Year From Date Issued ......................... . Application is hereby made to the San Joaquin Local Health District for a per oto construct and install the work herein described. This application is made lin L.compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO i N,7 . I.. . . .`l:-..t Y •• ... (._ ANSUS TRACT ........_...... . Owner's Name �_.'.. � ••• --....... ..Phone .................................... 1 Address ..� �. ----••---- City ...... :. ... �..... --------.Licen`se #,2_X-71-P-'l.. Phone z.?.� Contractor's Namet , a ' Installation will serve: Residence ❑Apartment House-[] Commercial ❑Trailer Court ' i iMotel E3 Other .............. ........... Number,of living units:_. Number of be ams Garbage Grinde .- Lot Size a:. `•-_ Water Supply:,Puiakic System and name ..•---- -.o_ � ...................... Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay E] Peat ElSandy Loam ❑ Clay Loam ❑ ❑ Hardpan Adobe fV Fill Material ----- If yes,type ------------ ------------ P (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 eermitted if public sewer is available within 200 feet) PACKAGE TREATMENT [ J SEPTIC TANK ] t jV(5 Six --------•----•--------••••----•-••---- .._ Liquid Depth .......................•-• " Material... No. Compartments .... Capacity -------------------- Type ........,........... � ........,........._J.� ,.. ,. ., .-_ r Line m Distance to nearest: Well -------------------s---..............Foundation .........------. -•--- Prop.. L ...................... LEACHING LINE No. of Lines .--_.___ _...._..-.. Length of each-line_....._ ( ..._._-.... Tota Length i D' Box :". ----- Type Filter Material ,lew .----•_.Depth Filter Material .-,1 ..................•..r...____.. Distance to nearest. Wel! ..� ............. Foundation `_.,�(�........... ... Property Line .. .................... SEEPAGE PIT ' Depth _sit_S...............Diameter.•_2.:a? --- Number ..._. ...._..._.._..... Rock Filled Yes ' No �] r w W Water Table Depth' ,��`:. hock Size ... Distance to nearest: Well l-U_ _ ._Foundation ... fes....------ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# I _._..........-•----------------------------- Date _.._........_,-------••----...---) ` Septic Tank {Specify Requirements} --._........ -- ...... . . Disposal Field (Specify Requirements) ....- ------- ----------------------__......rraw ..-- ... • ---.... -._ ..................... ......_._.....-•---•----......... and - - - ------------- ---required _ ..... side) reverse on addition k ( xisting t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I 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." • _ caner �� Signed ----------_--.... •------• By ._.......-•------ - �C�f .. .. Q-•`�.` ••r ....... Title ..-.--C.� . •� .. . ...................... (If other than owner) 1 , FOR DEPARTMENT USE ONLY V10 L\ APPLICATION ACCEPTED BY •-•-•----••-• . ----------........-•--•--- ••-•---......--_. DATE .... v._.. .. BUILDINGPERMIT ISSUED --- ---- --------- --_------- .....................................I..........................DATE ........ ADDITONAL COMMENTS . -..........---•----..--------._.-....................---....................................._.:.....----------*......•--•- : F.ina.. .. ' l Inspection by: ... . . .. . . ::/.. Date .... . —. . .. _. N .10A66IN LOCAL HEALTH DISTRICT �, 7/72 3 214