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FOR OFFICE USE: 0 4 I S 5..... Permit No. .. APPLICATION FOR SANITATION PERMIT 35�� ... '"J• ? ............... (Complete in Triplicate) Date Issued ...._.........:..... This Permit Expires I Year From 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 County Ordinance No. 549 and existing Rules and Regulations: � 1,• �. JOB ADDRESS/LOCATI NI .......-coG..Q _,....-a jj •GG�2,S. ,P' .........:............. ......CENSUS TRACT .............-.._......... Owner's Name ,.�. `6._.►�.. '�� Y_. t ' � Pho /e..................... . ... ......... ... :?.lµ ..±til..... .•.... City ... 5....- . / ` _ Address r :_ License # �L.� 1.... Phone �Q Contractor s Name - _... 4.... Installation will serve: Residence 0-4-p'artment House J-1 Commerciol ❑Trailer Court 0 Motel ❑Other ........................ ................... r� . Number of living units......... Number of rooms ,5........G rbage Grinder/1/�--_.- Lot Size .3_".. .................. Water Supply: Public System and name ..... -------- .................................................._Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ -Clay- ea ❑ Sandy Loam ❑ Clay loam ❑ ( Hardpan ❑ Adobe ill Material ,,et-'P. If yes,type ............................ (Pot plan, showing size of int, 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,) PACKAGE TREATMENT ( ] SEPTIC TANK I Size..................... -------------------- Liquid Depth ..................... Capacity .................... Type' ............... Material----.................. No. Compartments ....................... k Distance to nearest: Well ......Foundation ._ Prop. Line - ng .................. LEACHING LINE ( ] No. of Lines --------- -------------- Length of each line.________..._._.__..:...-..: Tota! Length .. E; D' Boz""`t"" '�"TYpe Filter Nlaferial`""""�77='Ciepth Filter Material .................. ......................... r ` Distance,to nearest: Well ._;..................... Foundation -----.......-----._-•-:- Property Line .-----:-•----..:...:.... I SEEPAGE PIT ( 1 Depth ------ .`---•_-_.... Diameter. ................ Number _----------- ----------- ,Rock.Filled .Yes d No (],C Water Table Depth -• . --.. _-------------•------..Rock Size ........_...........- ........... iA ... Pro Line" Distance to nearest: Well�...........-............-.........-.....Foundation -_-------._...... p. .._ fREPAIR/ADDITION(Prev. Sanitation Permit�# ----:--....... ...... Date .........................•-•----••) L Septic Tank (Specify Requirements) ------------------ - ........ - ...... _ Disposal Field (Specify Requirements) _----------------w....-••- `-....... ,. ., ----------------- :. -- ---•................... - -----_.........-•-------•--....--- ................................................. (Draw existing and required addition on 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 "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." v .:.. Signed ................ Own � By _ ................. TIN - j. other than owner) ¢� f R DEPARTMENT. USE ONLY APPLICATi N ACCEPTED BY .... _-••-•------------ ................................. DATE ...,, .. ....-7------_----- BUILDING,.PERMIT ISSUtDI....... =---•:..::....---- ......------••---•....:...............;_........----DATE . ......--....... .. --_-----------.. ADDITIONAL COMMENTS- '.............. `: t , . .. . ......................4 .... --•--...... V --........_ ................... -------I......._.............................................. . ..._.......'. .tel......... .... .... . .... . ..... . ............................................ . . . ......... . . ...........-................. ...Date - Final Inspection by: ....____-•• - .... .�... ............. —',SAN -JOAQUIN LOCAL' HEALTH DISTRICT {- 7/72 3 �y ] 3 24 ti -,La e_.. c�a M _